We express our sincere gratitude to the readers for their insight into our randomized controlled trial titled “Effect of mechanical bowel preparation with antibiotics and probiotics on postoperative ileus in patients undergoing posterior lumbar spine surgeries” [1]. We value their meticulous analysis of our findings and their constructive input in the discourse on this clinically significant topic. We concur with the commentators that our study failed to exhibit a significant advantage of mechanical bowel preparation (MBP) with antibiotics and probiotics in enhancing postoperative gastrointestinal recovery. The key outcome measures—time to first passage of flatus, return of bowel sounds, and first defecation— were statistically similar between the MBP and non-MBP groups, indicating that routine bowel preparation does not enhance postoperative bowel function in patients undergoing limited posterior lumbar spine procedures.

Furthermore, it is important to note that all cases of postoperative ileus occurred in the MBP group. Despite the study’s limited power to establish causality, this finding raises a significant concern about the potential adverse effects of MBP. According to the commentators, perioperative fluid shifts, dehydration, and electrolyte imbalances may reasonably lead to postoperative hypotension and delayed recovery. In our cohort, postoperative hypotension was more prevalent in the MBP group and was addressed conservatively, without long-term consequences.

We agree that our findings align with the growing literature challenging the standard application of MBP in spine surgery, especially in posterior approaches where direct bowel manipulation is not performed. Prior research in both spinal and non-spinal surgical cohorts has similarly indicated negligible benefits and increased patient discomfort associated with MBP [2-4]. Our findings further support a selective approach to bowel preparation for posterior lumbar spine surgery involving 1 or 2 levels, rather than a routine approach.

We recognize the constraints of our study, nota-bly the relatively small sample size and the focus on limited-level posterior lumbar procedures. Expanded multicenter trials encompassing more extensive spinal surgeries may elucidate the role of MBP in various surgical contexts.

We again express our gratitude to the readers for their perceptive remarks and the Editor for facilitating this significant academic discourse.