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Mechanical bowel preparation (MBP) with concurrent oral antibiotics has recently been the subject of many trials. In North America this has been integrated into patient pathways [22]. A recent survey (2017) by the European Society of Coloproctology observed that only 16.8% of the European surgeons used oral antibiotics with MBP prior to rectal resection [23]. This was largely attributable to the fact that most enhanced recovery protocols recommend avoiding MBP [24].

However, a French Research Group of Rectal Cancer Surgery (GRECCAR) multicenter trial noted that patients undergoing elective rectal cancer surgery without MBP (retrograde enema and oral laxatives) had a higher risk of infectious complications (34% vs. 16%, p = 0.005) [25]. A meta‐analysis of 38 randomized clinical trials including 8458 patients compared four preoperative management strategies (MBP with oral antibiotics, oral antibiotics only, MBP only, or no preparation). The cohort of patients receiving only oral antibiotics had the lowest rate of surgical site infection [26]. Several other studies have reported conflicting results [23, 27], and there remains several further prospective trials in progress.