Postoperative outcomes following mechanical bowel preparation before proctectomy: a meta-analysis D. E. Courtney, M. E. Kelly, J. P. Burke and D. C. Winter Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland Received 8 October 2014; accepted 14 March 2015; Accepted Article online 11 June 2015 Abstract Aim Previous meta-analyses of mechanical bowel prepa- ration (MBP) before colorectal surgery have grouped colon and rectal resection together. An increased post- operative morbidity has been suggested in the absence of MBP following proctectomy. The current study used meta-analytical techniques to evaluate the comparative outcome of patients who received MBP prior to proc- tectomy. Method A comprehensive search was performed for published studies examining the effect of MBP before proctectomy on patient outcome. Random effects meth- ods were used to combine data. Results Eleven studies including 1258 patients were identified. There was no significant difference in overall morbidity (OR 1.062, 95% CI 0.584–1.933, P = 0.844), anastomotic leakage (OR 1.144, 95% CI 0.767–1.708, P = 0.509), surgical site infection (OR 0.946, 95% CI 0.549–1.498, P = 0.812) or mortality (OR 1.377, 95% CI 0.549–3.455, P = 0.495) between those who did not and those who did receive MBP prior to proctectomy. Conclusion The current study did not demonstrate a beneficial effect of MBP prior to proctectomy, but the data were limited. Decision-making as to its use should be made on a case-by-case basis. Keywords Rectal surgery, surgical outcomes, surgical morbidity, anastomotic leak, mechanical bowel prepara- tion Introduction Mechanical bowel preparation (MBP) before colorectal resection is questionable and controversial in the modern perioperative care of colorectal patients [1,2]. While early analyses suggested a higher rate of anasto- motic leakage following MBP [3,4], more recent studies of larger patient cohorts have refuted this, but they still suggest MBP is associated with a higher rate of surgical site infection [1]. Although there is con- siderable consensus regarding the abandonment of MBP in elective colorectal surgery, many surgeons are hesitant in eliminating its use before proctectomy [5,6]. To date, meta-analyses on this subject have grouped colonic and rectal resection, but a recent randomized controlled trial has suggested an improved outcome fol- lowing MBP before proctectomy [7]. As a pelvic anas- tomosis is an independent risk factor for anastomotic leakage [8], most colorectal surgeons still use MBP before rectal cancer surgery [9] in the hope of reducing the incidence and severity of this potentially fatal com- plication [10,11]. A consensus must be reached from the published literature that focuses on the efficacy and safety of omitting MBP before proctectomy before this practice can be advocated. To address this, we performed a meta-analysis of all published data examining the omission of MBP before proctectomy. The aim of this study was to assess the comparative incidence of anastomotic leakage, pelvic abscess, overall morbidity and inpatient mortality in patients having and not having MBP. Method Literature search and study selection A systematic search of the Pubmed and Embase data- bases was performed for all papers published relating to MBP in the context of rectal resection and its associa- tion with postoperative morbidity and mortality. We used the following search algorithm: (rectal OR rectum Correspondence to: Danielle E Courtney, Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. E-mail: danielle.courtney34@gmail.com Colorectal Disease ª 2015 The Association of Coloproctology of Great Britain and Ireland. 17, 862–869 862 Meta-analysis doi:10.1111/codi.13026