The Effectiveness And Value Of Mechanical Bowel Preparation In Elective Colorectal Surgery:an Overview Of Meta-analysis And Systematic Review

ObjectiveTo overview the meta-analyses/systematic reviews of the effectiveness,safety and clinical value of mechanical bowel preparation(MBP)before elective colorectal surgery,providing a more reliable basis for clinical decision-making of medical caregivers.MethodsWe searched databases including CNKI,CBM,VIP,Wanfang data,PubMed,Embase,CINAHL,The Cochrane Library database from inception to December,2018.At the same time,by consulting clinical experts and carefully reading the list of references to supplement the search content,and retrieving the collection of authoritative conferences at home and abroad,Meta-analysis and systematic review of the effectiveness,safety and clinical value of mechanical bowel preparation before elective colorectal surgery were performed.Two researchers independently screened literature,extracted data and used AMSTAR 2 to evaluate the methodological quality of the included studies.The evidence level was evaluated by using GRADE evidence quality evaluation tool.The primary outcome of the study was to assess the incidence of wound infection,anastomotic leakage,surgical site infection,abdominal infection/abscess,mortality,reoperation.The second outcome of the study was to assess length of stay and extra-abdominal infection.Results1.A total of 17 meta-analyses/systematic reviews were included.There are 4 Chinese papers and 13 English papers.They are from the Netherlands,the United Kingdom,Canada,China,the United States,Ireland,Italy,Denmark,Switzerland and other countries.2.The results of AMSTAR 2 evaluation showed: high: 4(23.52%),Moderate:7(41.18%),and low 6(35.29%).The method quality assessment defects are mainly manifested by the lack of pre-design(23.52%)and the lack of literature publication status(only 11.76%).3.The GRADE Evidence rating system evaluated 6 primary outcome indicators,5 were of high quality and 1 were of low quality.4.There is no statistically significant differences in primary outcome measures(postoperative incision/wound infection,anastomotic leakage,surgical site infection,abdominal infection/abscess,mortality,reoperation rate)and secondary outcome measures(hospitalization time,extra-abdominal infection).ConclusionThis study demonstrates that the use of MBP before elective colorectal surgery does not affectthe incidence of postoperative complications compared with no MBP.Therefore,it is safe to not perform MBP before elective colorectal surgery.