Senna vs Polyethylene Glycol for Mechanical Preparation the Evening Before Elective Colonic or Rectal Resection

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Abstract
SEVERAL CONTROLLED studies have shown beyond any doubt that abdominal infective complications after colonic and rectal surgery were decreased by systemic antibiotic prophylaxis.1 Antiseptic enemas such as povidone iodine also have been shown to be bacteriologically2 and clinically3,4 efficient. Mechanical preparation plays a role as well, ensuring adequate colonic and rectal cleanliness.5,6 Although it has never been shown that endoluminal cleanliness decreased the rate of postoperative complications,7-12 most authors agree that mechanical cleansing is preferable before performing colonic resection,7 and it is used by 30% to 51% of North American colorectal surgeons.13-15 Several mechanical cleansing preparations are available, and these can be divided into volume-induced agents, such as mannitol or polyethylene glycol, and secretory and stimulant agents (laxatives), such as sodium phosphate or senna, sometimes used in association with various types of enemas (tap water, saline solution, or povidone iodine).3,4,16 Polyethylene glycol is used by many endoscopists because the fluid contents can easily be aspirated.17 Controlled studies in elective colorectal surgery have shown that cleanliness was better with polyethylene glycol than with water enema alone17 and better with senna compared with mannitol.16 However, to our knowledge, there are no prospective, controlled studies comparing polyethylene glycol with senna, particularly the evening before surgery. We therefore undertook this prospective, randomized multicenter study to compare both types of mechanical colonic preparations as regards colonic cleanliness in elective colonic or rectal resection.