The CHARM trial evaluated mechanical bowel preparation (MBP) before colorectal surgery. Its findings have influenced current enhanced recovery after surgery (ERAS) protocols. Based on current evidence, MBP alone (without oral antibiotics) before elective left colectomy:

• A Does not reduce surgical site infections or anastomotic leaks compared to no preparation, and is not routinely recommended in isolation ✓
• B Significantly reduces anastomotic leak rates and is mandatory in all colorectal cases
• C Should be combined with hypertonic phosphate enemas only in diabetic patients
• D Is replaced by IV metronidazole alone, which provides equivalent bowel preparation

Explanation

Multiple randomised controlled trials and meta-analyses (including the CHARM trial and Cochrane reviews) have demonstrated that mechanical bowel preparation alone before elective colorectal surgery does not reduce anastomotic leak rates, SSI, or mortality compared to no preparation. MBP causes patient discomfort, dehydration, and electrolyte imbalance. Current ERAS protocols recommend against routine MBP alone. However, the combination of MBP plus oral antibiotics (oral neomycin + metronidazole or erythromycin) does show benefit in reducing SSI (NSQIP data) and is advocated in recent ERAS 2023 guidelines.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.