Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial

Lijoi, Davide; Ferrero, Simone; Mistrangelo, Emanuela; Casa, Ilaria Della; Crosa, Marco; Remorgida, Valentino; Alessandri, Franco

doi:10.1007/s00404-009-0986-3

Cited by 54 publications

(59 citation statements)

References 20 publications

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“…It was impossible to mask the participants about the preparation methods, so whether performance bias existed or not was unclear. 22.9% of participants dropped out in one study, but the ITT analysis was not applied, which may have induced a high level of attrition bias [21]. Based on the guidelines suggested by the Cochrane Collaboration, the quality of the included studies was moderate to good, as illustrated in figure 2.…”

Section: Resultsmentioning

confidence: 99%

“…Patient discomfort due to oral catharsis was significantly severer than in case of no bowel preparation and enema [18,21,22]. The symptoms were also much severer in the minimal residue diet plus MBP group than the fasting only group; however, they were not different when compared with minimal residue diet [23].…”

Section: Resultsmentioning

confidence: 99%

“…One study compared the efficacy and adverse effects between oral sodium phosphate and sodium phosphate enema [18]. Four studies comparing MBP to non-MBP were meta-analyzed, non-MBP containing no bowel preparation or minimal residue diet [19,20,21,22]. One study comparing minimal residue diet plus oral sodium sulphate to minimal residue diet or fasting alone was also included in the meta-analysis [23].…”

Section: Resultsmentioning

confidence: 99%

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Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis

Zhang¹,

Xu²,

Su³

2015

Gynecol Obstet Invest

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Objective: To clarify the efficacy and side effects of mechanical bowel preparation (MBP) before gynecologic surgery. Methods: A systematic review was conducted. Embase, PubMed, the Cochrane Central Register of Controlled Trials in the Cochrane Library and China National Knowledge Infrastructure were searched. Randomized controlled trials on MBP prior to gynecologic surgery were included. The software package Revman 5.3 was used for statistical analysis. Odds ratio (OR) and standard mean deviation were calculated for dichotomous and continuous variable, respectively. Results: The quality of the included studies was moderate to good. MBP prior to laparoscopic gynecologic benign surgery or vaginal prolapse surgery has not been proven to be valuable for surgical performance, mainly involving visualization of the surgical field (OR 1.52, 95% confidence interval [CI] 1 to 2.32; Z = 1.95, p = 0.05), bowel handling (OR 2.21, 95% CI 0.83 to 5.84; Z = 1.59, p = 0.11), surgical complications (OR 1.3, 95% CI 0.46 to 3.67; Z = 0.5, p = 0.62) and bowel preparation. The discomfort due to oral catharsis is severer than no bowel preparation and enema, however without any difference between enema and no bowel preparation. Conclusion: The routine practice of MBP before gynecologic surgery needs to be reconsidered. This traditional clinical behavior has to be abandoned before benign laparoscopic surgery. Studies on the role of MBP for gynecologic laparotomy and gynecologic cancer are urgent.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis

Zhang¹,

Xu²,

Su³

2015

Gynecol Obstet Invest

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“…This raises the question of the necessity of MBP. In a blinded, randomized, controlled trial in gynecologic laparoscopic surgery for benign disease, a 7-day low-fiber diet gave as good exposure as PEG (scored by the surgeon) but was far better tolerated [48].…”

Section: Discussionmentioning

confidence: 99%

Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

et al. 2013

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Background Adequate working space is a prerequisite for safe and efficient minimal access surgery. No objective data exist in literature about the effect of mechanical bowel preparation (MBP) on working space in laparoscopic surgery. We objectively measured this effect with computed tomography in a porcine laparoscopy model. Methods Using standardized anesthesia, twelve 20-kg pigs without MBP and eight 20-kg pigs with MBP were studied with computed tomography at intra-abdominal pressure (IAP) levels of 0, 5, 10, and 15 mmHg. Volumes and dimensions of the pneumoperitoneum were measured on reconstructed CT images and compared between the pigs with and those without MBP. Results A reproducible and statistically significant increase of approximately 500 ml in pneumoperitoneum volume was found in the MBP group at all levels of IAP. This represents a 43 % relative increase at a pneumoperitoneum pressure of 5 mmHg, 21 % at IAP 10 mmHg, and 18 % at IAP 15 mmHg. Peak inspiratory pressure was lower at IAP 0 and 5 mmHg in the MBP group. Anteroposterior diameter in the group with MBP was lower at 0 mmHg, but abdominal dimensions were similar in both groups at all other IAPs. This shows that the gain in working space is due to a diminished volume of the intraabdominal content and not to compression or displacement of the bowel. Conclusions MBP increases working space by reducing bowel content. Especially at low intra-abdominal working pressures, the increase in working space associated with MBP could represent an important benefit in challenging laparoscopic surgery.

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“…Another randomized controlled study by Lijoi et al [10] evaluated the role of a 7-day minimal residue preoperative diet compared with that of an oral MBP for lapa- Table 4. Surgeon questionnaire scores evaluated by using a 5-point VAS when analyzed according to the uterine weight in patients who underwent total laparoscopic hysterectomy roscopic benign gynecological surgery.…”

Section: Discussionmentioning

confidence: 99%

Do We Need Mechanical Bowel Preparation before Benign Gynecologic Laparoscopic Surgeries A Randomized, Single-Blind, Controlled Trial

Mulayim

Karadağ²

2017

Gynecol Obstet Invest

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Aims: The primary objective of this study was to compare the effect of mechanical bowel preparation (MBP) with oral sodium phosphate (NaP) solution vs. MBP with NaP enema vs. fasting only with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery in patients undergoing benign gynecologic laparoscopic procedures. Methods: The patients were randomized into one of 3 groups: oral NaP, NaP enema, or fasting only. The primary surgeon and assistant(s) remained blinded to the randomization assignments. Intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery were assessed using a surgeon questionnaire based on Visual Analog Scales. Results: We enrolled 293 women, of whom 278 were randomized to receive oral NaP solution (n = 96), undergo NaP enema (n = 92), or perform fasting only (n = 90).No significant differences were found between the 3 groups. Conclusions: No differences were observed among patients who underwent MBP with oral NaP or NaP enema and those without MBP, with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery. No benefit of MBP was found when removing large uteri or when operating on patients with a high body mass index.

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Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial

Cited by 54 publications

References 20 publications

Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis

Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis

Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

Do We Need Mechanical Bowel Preparation before Benign Gynecologic Laparoscopic Surgeries A Randomized, Single-Blind, Controlled Trial

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