Bowel preparation

Preoperative bowel preparation has been part of the surgical dogma for patients undergoing planned colorectal, gynecologic, or other pelvic surgery for decades. With the introduction of enhanced recovery after surgery (ERAS), many dogmatic approaches to perioperative care were replaced by evidence-based approaches which may ultimately favorably impact the outcomes intended to be reduced by preoperative bowel preparations. There remains a greater volume of data in support of oral antibiotic preparation with mechanical bowel preparation when a preoperative bowel preparation is utilized. Mechanical bowel preparation alone carries no benefit, may be harmful in the perioperative setting, and should be avoided. Emerging research suggests that oral antibiotic preparation alone may be beneficial, and the ERAS perioperative landscape has introduced a new era that favorably impacts bowel-related outcomes even in the setting of no bowel preparation. As such, the role of preoperative bowel preparation warrants revisiting as perioperative care evolves.