Mechanical bowel preparation before gynecologic laparoscopic procedures: Is it time to abandon this practice?

Preoperative Mechanical Bowel Preparation for Gynecologic Surgeries: A Systematic Review with Meta-analysis

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.

The Effect of Mechanical Bowel Preparation on the Surgical Field in Laparoscopic Gynecologic Surgeries: A Prospective Randomized Controlled Trial

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.