Background: Basic surgical principles emphasize the need for bowel preparation before elective colorectal surgery. In emergent situations a two-stage procedure is performed in which bowel anastomosis is performed in the second stage. This is done to avoid complications associated with anastomotic leakage causing bacterial contamination of the intra-abdominal viscera. This basic surgical principle has been questioned by several investigators in relation to elective colorectal surgery. The goal of this study is to evaluate the safety and effectiveness of free tissue transfer of a segment of colon without preoperative bowel preparation.

Materials and Methods: Patients that underwent upper esophageal reconstruction with a segment of colon between September 2001 and April 2002 were evaluated. A retrospective chart review of all patients that did not have preoperative bowel preparation was done. All patients included in this study were maintained on a regular diet until the midnight before surgery. There was no selection bias of these patients as they were a group who did not understand or did not follow instructions given to them by the hospital’s department of preoperative testing.

Results: 9 patients underwent reconstruction using a segment of colon with ileum for the reconstruction of the hypopharynx and cervical esophagus with concominant reconstruction of the voice tube. All 9 patients healed and were able to tolerate a soft diet. One patient had a recurrence of his tumor. No deaths were noted in this study. One patient had a leak at the upper colon anastomosis, which was repaired using a pectoralis major muscle flap. One patient had an abdominal wall dehiscence with no evidence of infection.

Conclusions: This is the first report in the literature of free microvascular transfer of a segment of colon without preoperative preparation of the bowel. The outcomes of this study allow the plastic surgeon the option of performing the transfer of colon even the absence of preoperative preparation of the bowels. This option should not be considered as a first choice however; when necessary it can be done safely and effectively.