Preoperative mechanical bowel preparation versus no preparation for pediatric intestinal surgery: a systematic review and meta-analysis.

BACKGROUND

Mechanical bowel preparation (MBP) has traditionally been routine before pediatric intestinal surgery, based on the belief that it reduces the risk of infection. In adults, benefits are only observed when MBP is combined with oral antibiotics; however, evidence in pediatrics remains limited and inconsistent.

METHODS

We conducted a systematic review and meta-analysis (PROSPERO CRD420251133552) following PRISMA 2020 and Cochrane guidelines, searching databases up to August 2025. Eligible studies included Randomized controlled trials and comparative observational cohorts comparing MBP with no MBP in elective Pediatric intestinal surgery. The primary outcome was surgical site infection (SSI); secondary outcomes included anastomotic leak (AL), intra-abdominal abscess (IAA), ileus, bowel obstruction, and length of stay (LOS). Random-effects models produced pooled estimates, and certainty was assessed using the GRADE approach.

RESULTS

Seventeen studies involving 3,036 children were included. MBP showed no reduction in SSI, AL, or IAA, with moderate certainty for SSI and low certainty for AL/IAA due to rare events. MBP was associated with longer LOS and possible non-significant increases in ileus and obstruction.

CONCLUSION

Current evidence suggests that MBP offers no significant benefits in pediatric elective intestinal surgery and may even delay recovery. Within the framework of ERAS protocols, routine use of MBP appears unnecessary. However, MBP might still be required for specific functional or reconstructive indications. Further high-quality multicentre trials are essential before any definitive conclusions can be drawn regarding its discontinuation.