Background: MBP is used by all surgical specialties prior to surgery with the aim of reducing post-operative patient complications including anastomotic leak and to improve surgical view at laparoscopy..
Methods: A systematic literature search using the PRISMA guideline was undertaken using MEDLINE, EMBASE, GoogleScholar, The Cochrane Central Register of Controlled Trials and PubMed to identify all relevant articles comparing the clinical outcomes of MBP versus no-MBP and MBP versus single rectal enema in adults. Extracted articles were evaluated according to the GRADE system.
Results: 43 studies were identified in colorectal, gynaecological, urological and thoracic surgery: 38 comparing MBP to no-MBP (20 RCTs, three prospective and 15 retrospective cohort studies) and 5 comparing MBP to a single rectal enema (three RCT, one prospective and one retrospective cohort study). Studies in colorectal surgery focused on patient outcomes such as anastomotic leak and infectious morbidity and MBP did not improve patient outcomes. Gynaecological studies predominantly investigated surgical field of view and patient side effects from MBP. The gynaecological studies found surgical field of view was not enhanced by MBP and patients experienced significant discomfort from MBP.
Conclusions: Regarding gynaecological surgery specifically, MBP does not improve the surgical field of view in laparoscopic or vaginal procedures and increases patient discomfort. When findings from colorectal surgery are extrapolated to gynaecological surgery, there is no reduction in patient morbidity in the instance of inadvertent bowel injury. Evidence from high quality studies across surgical specialties suggests that the use of pre operative MBP should be abandoned.