While there is evidence to suggest that mechanical bowel preparation should not be used in isolation, there is renewed interest in determining the value of adding oral antibiotics to the preoperative regimen for elective colorectal procedures. For instance, a recent retrospective database analysis has suggested that there may be an important role for the combination of mechanical bowel preparation and oral antibiotics in reducing postoperative surgical site infections in elective colorectal surgery. Thus, this report aims to review relevant evidence addressing the clinical effectiveness, cost-effectiveness, and evidence-based guidelines for the use of standard, parenteral antibiotic prophylaxis with or without mechanical bowel preparation versus intravenous plus oral antibiotic prophylaxis with or without mechanical bowel preparation for patients undergoing elective colorectal procedures.

In the United States, oral mechanical bowel preparation (OMBP), defined as the use of an oral preparation given prior to surgery to clear fecal material from the bowel lumen, is often prescribed preoperatively for patients undergoing elective colorectal surgery. OMBP is sometimes used as a precaution in anticipation of possible iatrogenic bowel injury during abdominal and pelvic surgeries that do not entail resection of the colon or rectum (e.g., urologic or gynecologic procedures). OMBP is also routinely prescribed prior to colonoscopy to allow maximal visualization of the intraluminal bowel during the procedure. In 2009, more than 250,000 colorectal surgeries were recorded, most commonly for cancer or diverticulitis, and, in the majority of cases, in adults. In the context of colorectal surgery many have considered OMBP necessary for decreasing infectious complications, in particular by lowering anastomosis leakage rates associated with surgery. Complication rates for elective colorectal surgery range between 4 and 36 percent. A surgical site infection can substantially lengthen hospital stay from approximately 4 days to 21 days and increase costs from approximately $11,000 to $43,000. Therefore, reducing complication rates of elective colorectal surgery is an important goal. The purpose of this review was to systematically evaluate experimental and observational evidence on the benefits and adverse events associated with the use of OMBP in patients undergoing elective colorectal surgery. Patient and procedural characteristics that modify the effect of OMBP on outcomes were also reviewed. On the basis of the original topic nomination and an extensive stakeholder-driven process of topic development and refinement, we formulated the following Key Questions to guide the review: Key Question 1: How do various preoperative OMBP strategies compare with either no OMBP or with each other with respect to their effectiveness for preventing surgical or postsurgical complications? Does the effect vary by elective (a) right colon, (b) left colon, and (c) rectal surgery? Key Question 2: How do various preoperative OMBP strategies compare with either no OMBP or with each other with respect to presurgical and postsurgical adverse events? How do comparative adverse events vary (a) by OMBP strategy and (b) in subgroups of especially susceptible patients?

Bowel preparation for elective colorectal surgery has been performed for decades with the assumption to decrease infectious complications and anastomotic leaks. Nevertheless, the scientific basis of the same is still debatable. Various methods of bowel preparation are mechanical bowel preparation (MBP) with or without prophylactic oral antibiotics (POA), preoperative POA alone without MBP, and preoperative enema alone without MBP and POA. However, there is no consensus on the optimal type of bowel preparation. The available agents for MBP are polyethylene glycol (PEG) and sodium phosphate (NaP) or picosulphate. The most common prophylactic oral antibiotic regimen used in preoperative bowel preparation is Neomycin and Metronidazole a day before surgery, although the microbiological basis of this is unverified. Most studies around the beginning of this century indicate inadequate evidence for using MBP for colorectal surgery to suggest harm caused by the process and accordingly advise against it. However, several retrospective studies and meta-analyses, which were done after 2014, arguably demonstrate that preoperative MBP and POA reduce the postoperative surgical site infection rate. However, as per the current evidence, it can be suggested that MBP and preoperative POA can be safely included in the preoperative preparation of elective colorectal surgery.

This text reviews the areas of colorectal surgery that are at the cutting edge of innovation, paradigm shift and controversy with regard to diagnosis, patient selection, treatment algorithm, and therapeutic approaches. From the impact of enhanced recovery protocols on traditional colorectal practices, to that of novel strategies merging endoscopic and surgical techniques, to recent paradigm shifts in the management of common colorectal disorders, this text provides readers with an update on current controversies and evolving treatment rationale in the management of common colorectal diseases. Current Common Dilemmas in Colorectal Surgery provides a guide for the current common dilemmas that caregivers encounter in their daily practice. It is of great utility to colorectal surgeons, surgical oncologists and general surgeons practicing colorectal surgery, senior residents in general surgery training or surgical oncology or colorectal fellowships, allied healthcare professionals involved in the care of patients with colorectal disease, pharma and biomedical technology industry with an interest in current care of patients with colorectal disease.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US $10 billion per year. No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

While there is some evidence that suggests that mechanical bowel preparation (MBP) should not be used alone, there is renewed interested in determining the role of MBP, together with preoperative oral antibiotics. Recent retrospective analyses of large databases have suggested that there is an important role for the combination of MBP and oral antibiotics in reducing postoperative surgical site infections in elective colorectal surgery. The objective of this report is to review the clinical effectiveness, cost-effectiveness, and evidence-based guidelines related to intravenous antibiotic prophylaxis (alone) compared to intravenous antibiotics plus oral prophylaxis and/or MBP.

This second edition is an all-inclusive textbook with a unique algorithm-based approach to the evaluation and management of colorectal surgery disease. It examines the thought processes, technical tricks, and decision-making strategies for specific clinical situations. The book aims to utilise the experience its contributors have gained caring for patients with a wide range of colorectal diseases. The technical challenges of managing complex patients and the technical details that make these situations challenging are covered, and evidence and experience-based solutions are offered for surgeons of all levels. This book focuses on providing pragmatic advice and reproducible techniques that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems through an algorithmic approach.