Preparation of the intestine in patients undergoing major large-bowel surgery, mainly for neoplasms of the colon and rectum

Abstract

This paper reports the results of a randomized prospective trial of three régimes of preparation of 150 patients for major large-bowel surgery, the criterion being the frequency of postoperative sepsis. One régime provided only mechanical preparation of the bowel, another gave the same mechanical preparation and also phthalylsulphathiazole, and the third included mechanical measures plus phthalylsulphathiazole plus neomycin. As regards the use of bowel antiseptics, the combination of neomycin and phthalylsulphathiazole was not found to possess any advantage over sulphonamide alone. However, patients prepared by purely mechanical means fared substantially worse than those who had a combination of mechanical and antiseptic preparation. Gross faecal loading of the bowel and peritoneal contamination at operation were associated with a higher incidence of septic complications. These findings suggest that in the prevention of postoperative infection at least three precautions are desirable–the correction of gross faecal loading before operation, the use of preoperative intestinal antiseptics, and the avoidance of peritoneal contamination during operation.