INTRODUCTION INDICATIONS IDEAL BOWEL PREPARATION TYPES OF BOWEL PREPARATION ADJUNCTS SPECIAL SITUATIONS COMPLICATIONS CONCLUSION

Bowel Preparation has evolved in the last century. Goligher reported outcomes of mechanical bowel preparation in the 1970s. In 1980 Davis et al Formulated Polyethylene glycol (PEG). It became routine for most surgeons in the 1990s. It was thought to offer less postoperative risks. Sodium phosphate was then developed. Chang et al. developed a method of pulsed rectal irrigation combined with magnesium citrate.

There are approximately 109 to 1011 anaerobic bacteria and 105 to 107 aerobic bacteria in the colon, per gram of stool. The normal colonic flora comprises approximately 20 species of aerobic bacteria and more than 50 species of anaerobic bacteria. Bacteroides fragilis is the most frequently cultured species, followed by clostridia and peptostreptococci.

Recently, the role of bowel preparation has been questioned. Colonocytes receive nutrients from fermentation of FFA.

Colonoscopy Contrast studies Colonic surgery Bowel manipulation Encourage postoperative intestinal motility

Efficient Not time consuming. Should not alter colonic anatomy. Comfortable Not alter electrolytes Safe Cheap

Dietary restriction 3-5 days of low residue diet/ clear fluids. Use of cathartics e.g. senna, castor oil, bisacodyl. Repeated enemas. Safe & effective Time consuming, uncomfortable for pt, electrolyte disturbances, depletes pt, poor compliance Diet alone is ineffective.

Whole gut lavage Using high volumes (7-12L) of saline solution or balanced electrolyte solutions. Mannitol was used (1-2L) Effective in bowel preparation Uncomfortable for pt, electrolyte shift, poorly tolerated

Non absorbed sodium sulfate based liquid. Required large volumes (2-4L) No solid food for at least two hours prior to ingestion of the solution. 240 mL /10 minutes until rectal output is clear or 4 L . Dosage for nasogastric administration is 2030mL/min (1.2-1.8L/hr). Safer, faster, effective, well tolerated

used in renal insufficiency, ascites, cirrhosis, congestive cardiac failure Prophylactic antiemetics are required Salty taste, smell from sulphates Sulphate free & low volume solutions have been developed. Best for paediatric & elderly pt.

NaP is a low-volume hyperosmotic solution which contains 48g (400mmol) of monobasic NaP and 18 g (130mmol) of dibasic NaP per 100 ml. Less volumes are required, diluted prior to drinking to prevent emesis and must be accompanied by significant oral fluid to prevent dehydration. Equally effective and better tolerated.

Has rare, but severe electrolyte imbalances Not used in renal insufficiency, ascites, cirrhosis, congestive cardiac failure Not safe in paediatric & elderly pt. Causes colonic mucosal lesions Available as tablets (32-40tabs)

8-10L of saline introduce into the colon over 20-30mins. A closed circuit is used to prevent spillage. Performed through a caecostomy, appendectomy, balloon catheter in terminal ileum. Allows for primary resection & anastomosis.

Flavoring Nasogastric/Orogastric Tube Carbohydrate-Electrolyte Solution Enemas e. g tap water ,Soap Suds Bisacodyl (dulcolax) Laxatives: Magnesium citrate, Picolax (sodium picosulfate/magnesium citrate), senna Simethicone ; antiflatulent, antigas

Inadequate bowel preparation can result in missed lesions. cancelled procedures. increased procedural time. increase in complication rates. Elderly patients. Paediatric pt.

Bowel obstruction Perforated bowel Inflammatory bowel disease

Fluid & electrolyte imbalance. Abdominal pain/ cramping. Nausea & vomiting. Fluid overload Bloating pulmonary aspiration, Mallory-Weiss tear, PEG-induced pancreatitis and colitis, lavageinduced pill malabsorption, cardiac dysrhythmia,

Safety and effectiveness of the procedure is directly related to the quality of the bowel preparation done in anticipation of the procedure. Preparations associated with the best patient compliance safety, comfort, in order to achieve the best results are favourable

THANK YOU FOR LISTENING