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Purpose: Recent updates from randomized controlled trials (RCTs) indicated that mechanical and oral antibiotics bowel preparation (MOABP) can reduce post-operative surgical site infection (SSI), but its effect on anastomotic leakage (AL) remains controversial. This study systematically reviews and conduct trial sequential analysis (TSA) of the RCTs to determine whether MOABP can reduce SSI and AL after colorectal surgery. Methods: We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science for RCTs comparing MOABP to mechanical bowel preparation (MBP) alone, from database inception to February 1, 2025. Study quality was assessed using the Cochrane Risk of Bias tool. Meta-analysis, subgroup analysis, and sensitivity analysis were conducted using RevMan 5.3.1 software. TSA was performed with TSA software to evaluate the robustness of the primary outcomes. Results: = 3%, moderate-quality evidence). Subgroup analyses indicated reductions in superficial SSI, deep SSI, space and organ infection. TSA further confirmed the robustness of these findings. Conclusion: MOABP can effectively reduce the risk of SSI and AL in colorectal surgery. Pre-operative bowel preparation should consider incorporating oral antibiotics to optimize surgical outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/recorddashboard.
Lu et al. (Tue,) studied this question.