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Invited Critique
December 1, 2004

Mechanical Bowel Preparation for Elective Colorectal Surgery—Invited Critique

Arch Surg. 2004;139(12):1365. doi:10.1001/archsurg.139.12.1365

In less rational but arguably more interesting times, purveyors of apostasy were burned at the stake. Fortunately for Dr Bucher and his coauthors, this practice is currently condemned, and so their sole punishment will consist of having this critique appended to their disquieting publication.

These authors have chosen to question the near universally held belief that mandates the usage of mechanical bowel preparation prior to elective colon procedures. Alleged benefits of this regimen include lower rates of surgical site infections, decreased anastomotic leakage rates, improved bowel handling during operation, decreased need for stoma formation, and facilitation of intraoperative colonoscopy, when this operative adjunct is indicated. Some support for the authors’ thesis is to be found in the recent literature looking at trauma patients or those undergoing emergency colon resection, where numerous studies have shown high rates of safety in those patients undergoing primary repair or resection of left- and right-sided colonic lesions.