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Cardaillac C, Genest R, Gauthier C, Arendas K, Lemyre M, Laberge P, Abbott J, Maheux-Lacroix S. Preoperative Mechanical Bowel Preparation for Gynecologic Surgeries: A Systematic Review with Meta-analysis. J Minim Invasive Gynecol 2023; 30:695-704. [PMID: 37150431 DOI: 10.1016/j.jmig.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of mechanical bowel preparation (MBP) before benign laparoscopic or vaginal gynecologic surgeries. DATA SOURCES Database searches of MEDLINE (PubMed), Embase (OVID), Cochrane Central Register of Controlled Trials, and Web of Sciences and citations and reference lists published up to December 2021. METHODS OF STUDY SELECTION Randomized clinical trials in any language comparing MBP with no preparation were included. Two reviewers independently screened 925 records and extracted data from 12 selected articles and assessed the risk of bias with the Cochrane risk-of-bias tool for randomized trials tool. A random-effects model was used for the analysis. Surgeon findings (surgical field view, quality of bowel handling and bowel preparation), operative outcomes (blood loss, operative time, length of stay, surgical site infection), and patient's preoperative symptoms and satisfaction were collected. TABULATION, INTEGRATION, AND RESULTS Thirteen studies (1715 patients) assessing oral and rectal preparations before laparoscopic and vaginal gynecologic surgeries were included. No significant differences were observed with or without MBP on surgical field view (primary outcome, risk ratio [RR] 1.01, 95% confidence interval [CI] 0.97-1.05, p = .66, I2 = 0%), bowel handling (RR 1.01, 95% CI 0.95-1.08, p = .78, I2 = 67%), or bowel preparation. In addition, there were no statistically significant differences in perioperative findings. MBP was associated with increased pain (mean difference [MD] 11.62[2.80-20.44], I2 = 76, p = .01), weakness (MD 10.73[0.60-20.87], I2 = 94, p = .04), hunger (MD 17.52 [8.04-27.00], I2 = 83, p = .0003), insomnia (MD 10.13[0.57-19.68], I2 = 82, p = .04), and lower satisfaction (RR 0.68, 95% CI 0.53-0.87, I2 = 76%, p = .002) compared with controls. CONCLUSIONS MBP has not been associated with improved surgical field view, bowel handling, or operative outcome. However, in view of the adverse effects induced, its routine use before benign gynecologic surgeries should be abandoned.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics, Gynecology and Reproductive Medicine (Dr. Cardaillac), Nantes University Hospital, Nantes, France; Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada.
| | - Rosalie Genest
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Caroline Gauthier
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada; Department of obstetrics and gynecology (Dr. Gauthier), CHU Sainte-Justine, Chemin de la Côte Sainte-Catherine, Montréal, Canada
| | - Kristina Arendas
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Madeleine Lemyre
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Philippe Laberge
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Jason Abbott
- Division of Women's Health (Dr. Abbott), School of Clinical Medicine, UNSW, Sydney, Australia
| | - Sarah Maheux-Lacroix
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
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Chu L, Liang J, Wu S, Jin X, Li H, Tong X. Comparative evaluation of enema alone and in combination with oral polyethylene glycol for bowel preparation before transvaginal pelvic floor reconstruction in elderly patients: a retrospective cohort study. J OBSTET GYNAECOL 2022; 42:2406-2410. [PMID: 35666941 DOI: 10.1080/01443615.2022.2069002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this retrospective study was to assess the value of using an enema alone for mechanical bowel preparation (MBP) before transvaginal pelvic floor reconstruction (TPFR) in patients ≥65 years old. In total, 190 patients were included [81 in the enema group vs. 109 in the enema + polyethylene glycol (PEG) group]. The levels of serum potassium (p = .004) and calcium (p = .005) were higher in the enema group after surgery. The decrease in serum calcium was more significant in the enema + PEG group (p = .027). More patients in the enema + PEG group developed hypokalaemia (p = .035) or hypocalcaemia (p = .008) after surgery. The incidence of thrombus and surgical site infection was similar and earlier bowel movement was evident in the enema group (p = .000). Overall, the enema group used more laxatives (p = .026). Using enema alone before TPFR reduces the incidence of electrolyte disturbances with no increase in surgical complications in elderly patients.IMPACT STATEMENTWhat is already known on this subject? TPFR is an effective treatment for pelvic organ prolapse (POP) in elderly women. Bowel preparation performed before gynecological surgery can reduce surgical site infection, but increase discomfort and electrolyte disturbance.What do the results of this study add? The levels of serum potassium and calcium were lower in the enema + PEG group than in the enema group after surgery and more patients developed hypokalaemia or hypocalcaemia in the enema + PEG group. The incidence of thrombus and surgical site infection was similar between the two groups. Bowel movement was earlier in the enema group.What are the implications of these findings for clinical practice and/or future research? Using enema alone before TPFR reduces the incidence of electrolyte disturbance and does not increase surgical complications. This conclusion needs to be confirmed by random controlled trial studies in the future.
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Affiliation(s)
- Lei Chu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junhua Liang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siyu Wu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xia Jin
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huaifang Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaowen Tong
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Ozturk UK, Acar S, Akış S, Keles E, Alınca CM, Api M. The Effect of Mechanical Bowel Preparation on the Surgical Field in Laparoscopic Gynecologic Surgeries: A Prospective Randomized Controlled Trial. J INVEST SURG 2022; 35:1604-1608. [PMID: 35636766 DOI: 10.1080/08941939.2022.2081389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the effects of mechanical bowel preparation (MBP) on the intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery in patients undergoing elective laparoscopic gynecological surgeries. METHODS The patients randomized to a MBP group and a no preparation (NMBP) group. The senior surgeon remained blinded to the bowel regimen used by the patient. Intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery were evaluated using a numeric rating scale (NRS). RESULTS We enrolled 120 patients, of whom 109 completed the study, with 51 and 58 patients in the MBP and NMBP groups, respectively. The intraoperative visualization of the surgical field, intestinal load, and NRS scores for overall ease of surgery were better in the NMBP group (p = .03, p = .048, and p = .022, respectively). The results of the assessments also revealed no significant differences in surgical field visualization, ease of bowel handling, overall ease of surgery, or the time that patients experienced passage of flatus between obese (BMI > 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) patients in the two groups. CONCLUSIONS The current study revealed that MBP did not improve the intraoperative visualization of the surgical field or the overall ease of surgery. Moreover, MBP had no benefit when operating on patients who had a high BMI. Therefore, we do not recommend routine MBP before laparoscopic gynecological surgeries.
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Affiliation(s)
- Ugur Kemal Ozturk
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sami Acar
- Department of General Surgery, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Serkan Akış
- Department of Gynecologic Oncology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Cihat Murat Alınca
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Kathopoulis N, Chatzipapas I, Valsamidis D, Samartzis K, Kipriotis K, Loutradis D, Protopapas A. Mechanical bowel preparation before gynecologic laparoscopic procedures: Is it time to abandon this practice? J Obstet Gynaecol Res 2021; 47:1487-1496. [PMID: 33559272 DOI: 10.1111/jog.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/12/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine the influence of mechanical bowel preparation on surgical field visualization and patients' quality of life during benign gynecologic laparoscopic procedures. METHODS A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients to one of the following three groups: liquid diet on the preoperative day; mechanical bowel preparation with oral polyethylene glycol (PEG) solution; minimal residue diet for 3 days. Primary outcomes included assessment of the condition of small and large bowel and the overall quality of the surgical field. Additional measures included assessment of patients' preoperative symptoms, tolerance of the preparation method and compliance to the protocol, postoperative symptoms and bowel function. RESULTS One hundred forty-four patients were randomized as follows: 49 to liquid diet, 47 to mechanical bowel preparation, and 48 to minimal residue diet. Most characteristics were similar across groups. The intraoperative surgical view and the condition of large and small bowel were equal or inferior at the patients who received mechanical bowel preparation compared with the other groups. The 4-point Likert scale scoring for small bowel (2.51 vs. 2.72 vs. 2.81, p = 0.04), large bowel (2.26 vs. 2.38 vs. 2.48, p = 0.32) and overall operative field quality (2.34 vs. 2.67 vs. 2.67, p = 0.03) demonstrated no advantage from the use of preoperative mechanical bowel preparation over liquid diet and minimal residue diet, respectively. Preoperative discomfort was significantly greater in the mechanical bowel preparation group. CONCLUSION Mechanical bowel preparation before gynecologic laparoscopic operations for benign pathology could be safely abandoned. CLINICAL TRIAL REGISTRATION ISRCTN registry, https://doi.org/10.1186/ISRCTN59502124 (No 59502124).
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Affiliation(s)
- Nikolaos Kathopoulis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Samartzis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kipriotis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Diakosavvas M, Thomakos N, Haidopoulos D, Liontos M, Rodolakis A. Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature. Arch Gynecol Obstet 2020; 302:1049-1061. [PMID: 32740871 DOI: 10.1007/s00404-020-05704-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this review is to assess the impact of mechanical and oral antibiotics bowel preparation on surgical performance and to investigate their role before gynecologic surgical procedures regarding the infection rates. We also aim to study the updated evidence regarding the use of these different types of bowel preparation, as well as the current preoperative practice applied. METHODS An extensive search of the literature was conducted with Medline/PubMed, and the Cochrane Library Database of Systematic Reviews being used for our primary search. RESULTS To date, due to the conflicting guidelines by the scientific societies, surgeons do not use a specific pattern of bowel preparation regimen. There are no strong evidence supporting mechanical bowel preparation, but instead, in many cases, patients' adverse effects, both physiological and psychological have been noted. On the other hand, the combined use of oral antibiotic and mechanical bowel preparation has been proven beneficial in colorectal surgery in reducing postoperative morbidities. CONCLUSION Based on current literature, in gynecologic surgeries with minimal probability of intraluminal entry, a regimen without any bowel preparation should be applied. The combined administration of both mechanical and oral antibiotic bowel preparation, or even the use of the oral antibiotics alone, should be preserved for cases of increased complexity, where bowel involvement is highly anticipated, such as in gynecologic oncology, as stated in the ERAS protocols. Nonetheless, further research specific to gynecologic surgery is required.
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Affiliation(s)
- Michail Diakosavvas
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece.
| | - Nikolaos Thomakos
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece
| | - Dimitrios Haidopoulos
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece
| | - Michael Liontos
- Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece
| | - Alexandros Rodolakis
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece
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Diakosavvas M, Thomakos N, Psarris A, Fasoulakis Z, Theodora M, Haidopoulos D, Rodolakis A. Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery. ScientificWorldJournal 2020; 2020:8546037. [PMID: 32110164 PMCID: PMC7042550 DOI: 10.1155/2020/8546037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022] Open
Abstract
Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has been a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence. Mechanical bowel preparation in minimally invasive and vaginal gynecologic surgery is strongly debated, since many studies have not confirmed its effectiveness, neither in reducing postoperative infectious morbidity nor in improving surgeons' performance. A comprehensive search of Medline/PubMed and the Cochrane Library Database was conducted, for related articles up to June 2019, including terms such as "mechanical bowel preparation," "vaginal surgery," "minimally invasive," and "gynecology." We aimed to determine the best practice regarding bowel preparation before these surgical approaches. In previous studies, bowel preparation was evaluated only via mechanical measures. The identified randomized trials in laparoscopic approach and in vaginal surgery were 8 and 4, respectively. Most of them compare different types of preparation, with patients being separated into groups of oral laxatives, rectal measures (enema), low residue diet, and fasting. The outcomes of interest are the quality of the surgical field, postoperative infectious complications, length of hospital stay, and patients' comfort during the whole procedure. The results are almost identical regardless of the procedure's type. Routine administration of bowel preparation seems to offer no advantage to any of the objectives mentioned above. Taking into consideration the fact that in most gynecologic cases there is minimal probability of bowel intraluminal entry and, thus, low surgical site infection rates, most scientific societies have issued guidelines against the use of any bowel preparation regimen before laparoscopic or vaginal surgery. Nonetheless, surgeons still do not use a specific pattern and continue ordering them. However, according to recent evidence, preoperative bowel preparation of any type should be omitted prior to minimally invasive and vaginal gynecologic surgeries.
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Affiliation(s)
- Michail Diakosavvas
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Thomakos
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Psarris
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynaecology, “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Defining and mitigating the challenges of an older and obese population in minimally invasive gynecologic cancer surgery. Gynecol Oncol 2018; 148:601-608. [DOI: 10.1016/j.ygyno.2017.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 12/11/2022]
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