Appropriate Bowel Preparation for Laparotomy Gynecologic Surgery: A Prospective, Surgeon-Blinded Randomized Study

Abstract

Objective: To compare the surgeon's satisfaction during gynecological laparotomy surgery and patient's satisfaction as well as quality of life (QOL) among 3 groups of bowel preparations: no enema vs. sodium chloride enema vs. soap-suds enema (SSE). Materials and Method: Three hundred and thirty three women undergoing gynecological laparotomy surgery and without risks to bowel lumen entry between November 2014 and October 2015 were randomized to receive no enema (n = 111), sodium chloride enema (n = 111) or SSE (n = 111) for bowel preparation. Surgeons, who were blinded for the type of bowel preparation, assessed the surgical visualization and the efficacy of bowel packing. The patients' satisfaction and the QOL were also assessed on the days of admission, operation, post-operation, and discharge. Results: The patients' features of the 3 groups were well balanced. The surgeon's satisfaction was rated excellent as 56.8, 63.1 and 65.8% in the no-enema, sodium chloride and SSE groups (p = 0.830), respectively. The patients in the no-bowel-preparation group were satisfied more significantly than the other groups (p = 0.001). No significant differences in QOL were observed among the 3 groups. Conclusion: The type of bowel preparation for exploratory gynecologic surgery did not affect the surgical visualization and the QOL of the patients.

Role of Oral Antibiotic for Bowel Preparation before Gynecologic Oncology Surgery

“…In another study, 333 women who had gynecological procedures were included. Overall surgeon satisfaction, operating perspective, and bowel packing efficacy were not significantly different between the two bowel preparation methods in this study (15) .…”

“…Suadee and Suprasert (15) conducted a study on patients underwent gynecologic surgery and compared no bowel preparation with MBP. The study found no significant differences among each group regarding the return to bowel function.…”

“…The goals of the bowel preparation are better vision of the surgical field, simpler bowel packing, and less pollution of the peritoneal cavity and surgical site in the event of bowel entrance (4) .…”

Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery

“…We were able to identify only 1 RCT that studied the use of preoperative enemas during gynecologic laparotomy surgery. 12 Perioperative complications, surgical field visualization, efficacy of bowel packing, and surgeon and patient satisfaction were compared following no preoperative enema vs sodium chloride enema vs soap-suds enema. Of note, patients who were expected to have extensive surgery or entry in the bowel lumen were excluded.…”