Is mechanical bowel preparation still necessary for gynecologic laparoscopic surgery? A meta‐analysis

Huang, Huansen; Wang, Haiyan; He, Mei

doi:10.1111/ases.12155

Cited by 13 publications

(8 citation statements)

References 29 publications

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“…Meta-analyses[ 8 - 12 ] have been published on MBP in elective colorectal surgery showing mixed results, with most studies demonstrating no difference in infective complications between patients receiving MBP or control treatment, although control treatment varied significantly between the use of a rectal enema or absolutely no preparation. Similar results have been found in gynaecological[ 13 , 14 ] and urological[ 15 , 16 ] surgery where studies have shown no benefits in visualisation, bowel handling or complication rates between patients treated with bowel preparation and those given no bowel preparation. As a result of this inconclusive evidence, several studies have established that practice varies significantly between countries, and even surgeons in the same institution[ 17 , 18 ].…”

Section: Introductionsupporting

confidence: 82%

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Rollins¹,

Javanmard‐Emamghissi²,

Lobo³

2018

WJG

141

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AIMTo analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODSMeta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery.RESULTSA total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures.CONCLUSIONIn the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

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Section: Introductionsupporting

confidence: 82%

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Rollins¹,

Javanmard‐Emamghissi²,

Lobo³

2018

WJG

141

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“…Regardless of the type of procedure (laparoscopy, robotic, or vaginal surgery), routine administration of MPB seems to offer no advantage to any of the objectives mentioned above [24][25][26]. Surgical field visualization is irrelevant to the type of preoperative bowel preparation [25], bowel handling is the same whether MBP is used or not, surgical site infection rates are not affected by MBP use [26], LOS is not increased when MBP is omitted 4 e Scientific World Journal [9,19], while patients' discomfort and adverse physiologic effects are significantly higher when oral laxatives are used [24,25]. e most common MBP regimens include the use of laxatives which are administered either orally or rectally [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical field visualization is irrelevant to the type of preoperative bowel preparation [25], bowel handling is the same whether MBP is used or not, surgical site infection rates are not affected by MBP use [26], LOS is not increased when MBP is omitted 4 e Scientific World Journal [9,19], while patients' discomfort and adverse physiologic effects are significantly higher when oral laxatives are used [24,25]. e most common MBP regimens include the use of laxatives which are administered either orally or rectally [24,25]. Sodium phosphate (NaP) can be used either as an enema or as an oral preparation, while polyethylene glycol is used orally.…”

Section: Discussionmentioning

confidence: 99%

“…Other laxatives such as lactulose, sorbitol, glycerin, ducosate, bisacodyl, or castor oil are scarcely prescribed [1]. e negative effects of bowel preparation include patients' discomfort, such as postoperative pain, nausea, vomiting, abdominal distension, insomnia, weakness, and various physiologic changes [24,25]. BP with bisacodyl and sodium phosphate resulted in severe dehydration which led to a significant decrease in exercise capacity and weight.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

Diakosavvas

Thomakos

Psarris

et al. 2020

The Scientific World Journal

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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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“…The routine use of MBP for gynecologic laparoscopic surgery has not been recommended [3], but some questions remain to be answered. No controlled trial in the literature has compared the effects of MBP with oral sodium phosphate (NaP) vs. NaP enema with respect to intraoperative visualization of the surgical field, ease of bowel handling, and overall ease of surgery.…”

mentioning

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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Is mechanical bowel preparation still necessary for gynecologic laparoscopic surgery? A meta‐analysis

Abstract: Our results suggest that routine use of MBP for gynecologic laparoscopic surgery should not be recommended. However, additional randomized controlled trials using large samples are needed to confirm these findings.

Cited by 13 publications

References 29 publications

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

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

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