It is well known that colo-rectal operation has the major risk of contamination in peritoneal cavity and complication related to wound sepsis caused by fecal organism. For many years surgeons have been aware of the value of bowel preparation, including use of many kinds of oral antibiotics or simple mechanical preparation, prior to colonic operation as a methods of reducing the bacterial content.
Although numerous investigator have demonstrated the efficacy of preoperative nonabsorbable oral antibiotics in the reduction of the normal colonic flora at the time of surgery, some argument remains concerning whether or not this reduction of intestinal flora by antibiotics is more effective in diminishing the complications from, infection than simple mechanical preoperative bowel cleaning.
Optimal method of preparation of -the large bowel for operation is controversal upto now. This series includes 563 patients who had operations on the colo-rectum during the 11 year period from 1965 to 1976 at Department of Surgery, Yonsei University College of Medicine.
Analytical data are composed of 2 groups which are unprepared´ group of 168 cases and prepared group of 395 cases.
The latter is divided into 3 groups those are:
146 cases of Neomycin treated:
66 cases of Kanamycin treated,
183 cases of Mechanical bowel cleansing.
We obtained following conclusion from the analysis.
1) Undoubtedly, the preoperative bowel preparation is essential to colonic surgery in regarding to high incidence of postoperative complications in the unprepared group.
2) No superiority could be shown for any one of the three methods used in this series.
However, optimal method should be selected in relation to the condition of patients. The use of intestinal antibiotics should be considered only when there is partial obstruction, or an anticipated extraperitoneal anastomosis is done.
A combination of antibiotics to have bacteriocidal activity against both aerobic and anaerobic organisms would be more, appropriate.
Otherwise mechanical preparation alone would be appear to be adequate.
3) In emergency case, the instilation of antiseptic solution such as 10% Povidone iodine into the colon at operating table should be considered.
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