Bowel preparation for elective surgery

Bowel preparation for procedures on intestinal tract is particularly relevant to colorectal surgery. The patient is protected from a huge reservoir of pathogenic, aerobic anaerobic bacteria, present in the colon &distal small intestine by a mucosal membrane.  Surgical disruption of barrier may cause the escape of these pathogens into the peritoneal cavity with the potential for serious infections.  Mechanical bowel preparation eliminates the bulk of the stool and reduces bacterial count, facilitates the operative manipulation of the bowel and enhances the effect of antibiotics but alone it cannot reduce bacterial count in residual faeces.  Mechanical regimens vary and include more leisurely regimen of dietary restrictions, enemas or more rapid cleansing with whole gut lavage techniques.  The regimens are not necessary exclusive and can be employed in various combinations.

REGIMEN I

DAY MINUS 3
Last full meal at dinnertime.
DAY MINUS 2
Clear liquid diet, unless patient is on a medical fluid restriction.
Magnesium citrate 240 ml after breakfast.
DAY MINUS 1
Clear liquid diet, unless patient is on a medical fluid restriction.
Polyethylene glycol solution 4L per oral after breakfast
Neomycin & erythromycin base 1 gm each per oral at 1, 2, & 11 PM
DAY 0
Cefoxitin 1 gm I/V at 7:30 pm.
Skin incision for colostomy
Cefoxitin 1 gm 4 hours after completion of the first infusion if the patient is still undergoing surgery.

REGIMEN II

  1. 72 hours before surgery 45 ml of castor oil or (30 ml MgSO4)
  2. 48 hours before surgery patient on clear fluid 45 ml of castor oil after breakfast.
  3. 36 hours before surgery, Kleen enema.
  4. 24 hours before surgery 45 ml of castor oil.  In case of colostomy or ileostomy closure, wash the distal loop with normal saline.
  5. Nothing per oral eight hours before operation.
  6. Cefoxitin 1 gm I/V just before surgery.
  7. Cefoxitin 1 gm four hours after completion of the first infusion if the patient is still undergoing surgery.
Every effort should be made to have a completely empty colon before surgery.
In obstructed cases, bowel can be prepared on operating table. In case of distal colonic stenosing lesion, proximal colon is cleared of faecal matter by three methods.
  • Retrograde Muir’s tube via colotomy.
  • Prograde Malecot catheter via appendicectomy stump.
  • Tube inserted through a small stab incision in terminal ileum.
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