Q: 檢查/手術前為什麼需要Colon prep ？
A:
Colon prep 要不要做？
依據EBM，只有做colon prep不會降低手術部位感染和術後並發症發生率[1-5]。而且使用enema還會造成病人很大的不舒服。因此，手術前可以選擇不需要做colon prep。然而，近期的研究有提到，要是colon prep + per oral antibiotic use跟colon prep而已或systemic antibiotic use而已比較，兩者一起使用確實可以降低手術部位感染、術後腸阻塞、吻合口漏等並發症 [5-8]。因此建議在做colon prep的時候也用上prophylactic antibiotic.
小總結：colon prep要做，要同時加給prophylactic oral antibiotic (neomycin or erythromycin base).
References
1. Cochrane Database Syst Rev. 2011 Sep 7; (9):CD001544. Mechanical bowel preparation for elective colorectal surgery. doi: 10.1002/14651858.CD001544.pub4.
2. Int J Colorectal Dis. 2012 Jun;27(6):803-10. doi: 10.1007/s00384-011-1361-y. Epub 2011 Nov 23. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis.
3. Can J Surg. 2010 Dec; 53(6):385-95. Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons.
4. J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):737-52. doi: 10.1016/j.jmig.2015.04.003. Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review.
5. Clin Colon Rectal Surg. 2013 Sep; 26(3): 146–152. doi: 10.1055/s-0033-1351129. Bowel Preparation before Elective Surgery
6. Dis Colon Rectum. 2016 Jan;59(1):70-78. Comparing Mechanical Bowel Preparation With Both Oral and Systemic Antibiotics Versus Mechanical Bowel Preparation and Systemic Antibiotics Alone for the Prevention of Surgical Site Infection After Elective Colorectal Surgery: A Meta-Analysis of Randomized Controlled Clinical Trials.
7. Langenbecks Arch Surg. 2016 Aug;401(5):573-80. doi: 10.1007/s00423-016-1461-9. Epub 2016 Jun 20. Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights.
8. J Am Coll Surg. 2017 Jan;224(1):59-74. doi: 10.1016/j.jamcollsurg.2016.10.029. Epub 2016 Nov 30. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.
9. Dis Colon Rectum. 1998 Oct;41(10):1223-5. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy--timing is the key!
