Mechanical bowel preparation for laparoscopic hysterectomy, is it really necessary?

Bakay, Kadir; Aytekin, Fatih

doi:10.1080/01443615.2017.1318268

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…There were no differences in intraoperative visualization, bowel handling or overall ease of the operation 16 . Bakay et al, tried to compare the effects of MBP on field of vision and surgical comfort during total laparoscopic hysterectomy, using a more complex Visual Indexing (VI) tool and they reported that the duration of the operation was not affected by the use of MBP and the VI score 17 …”

Section: Discussionmentioning

confidence: 99%

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

Kathopoulis

Chatzipapas

Valsamidis

et al. 2021

J of Obstet and Gynaecol

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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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Section: Discussionmentioning

confidence: 99%

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

Kathopoulis

Chatzipapas

Valsamidis

et al. 2021

J of Obstet and Gynaecol

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“…Most randomized controlled trials (RCTs) compare oral MBP to no preparation regimen, besides fasting or a type of low residue diet [17][18][19][20][21]. Fewer studies compare oral MBP to enema MBP [11,13].…”

Section: Bowel Preparation Before Minimally Invasive Gynecologicmentioning

confidence: 99%

“…Despite these results, the fasting-only approach was recommended after taking into consideration the distressfulness and the adverse effects of MBP on women [17]. Unlike Won et al, Bakay and Aytekin in 2017 investigated the field of vision and surgical comfort during total laparoscopic hysterectomy procedures in 102 patients, using a visual indexing tool based on anatomic landmarks and found no differences in surgical view or intraoperative time between the group receiving oral MBP and the only 2 e Scientific World Journal [21].…”

Section: Bowel Preparation Before Minimally Invasive Gynecologicmentioning

confidence: 99%

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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“…Preoperative mechanical bowel preparation (MBP) has been routinely used for gynaecological laparoscopy, hypothetically to improve intraoperative bowel handling and visualization of the operative field [1][2][3][4][5]. The studies investigating the effect of MBP on gynaecological laparoscopy [1,3,[6][7][8][9][10][11] indicate that MBP has little or no benefit on improving the operative field visualization and intraoperative bowel handling. The methods used for the evaluation of those outcomes were subjective in the literature including 4/5/10point Likert scales rated verbally as excellent to poor by the operating surgeons [1,3,6,[11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the degree of Trendelenburg should be well-adjusted to the minimum where the operative field is adequate to proceed safely. As similar to PP, using a standard TIA throughout the surgical procedure has been a common practice in the literature [1,8,[21][22][23][24]. The TIAs in those studies were usually between 25 • and 40 • and sometimes even steeper depending on the surgical condition that reflects the general practice for adjustments of PP values This study aimed to test the null hypothesis that preoperative MBP does not affect the visualization of the operative field and does not enable lower TIA and PP values at a standardized method of anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Mechanical bowel preparation prior to gynaecological laparoscopy enables better operative field visualization, lower pneumoperitoneum pressure and Trendelenburg angle during the surgery: a perspective that may add to patient safety

Kalkan¹,

Yassa²,

Bakay³

et al. 2021

Clin. Exp. Obstet. Gynecol.

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Background: To find the effects of mechanical bowel preparation (MBP) on operative field visualization, and to measure pneumoperitoneum pressure (PP) and Trendelenburg inclination angle (TIA) values. Methods: In this two-centred, randomised, single-blind and controlled study, 90 patients who underwent laparoscopic gynaecological surgery for benign conditions were included. After the exclusions, 44 patients received MBP with oral sodium phosphate enema (study group) and 42 did not receive bowel preparation or underwent diet restrictions (control group). An objective visual index, PP and TIA were measured in a stepwise design of assessments. Results: The Visual Index at first inspection right after establishing a 12 mmHg PP and a standard 30 • TIA was found to be significantly in favour of the study group (p = 0.015). The lowest reached TIA in standard 12 mmHg PP following stepwise decrease was observed as 15.2 • and 25 • in the study and control groups, respectively (p < 0.001). The lowest reached PP was 8.9 mmHg and 11.9 mmHg in the study and control groups, respectively (p < 0.001). Patients who received MBP reported significantly higher levels of negative discomfort measures (p < 0.032), however 80% of those reported MBP as acceptable. Conclusion: Significantly better operative field visualization, lower TIA and PP was achieved with MBP. MBP enabled a decrement of either 10 • in TIA or 3 mmHg in PP with an adequate operative field to proceed safely for the benign gynaecological laparoscopic operations in exchange for acceptable discomfort for the patients.

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Mechanical bowel preparation for laparoscopic hysterectomy, is it really necessary?

Cited by 9 publications

References 10 publications

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

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

Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

Mechanical bowel preparation prior to gynaecological laparoscopy enables better operative field visualization, lower pneumoperitoneum pressure and Trendelenburg angle during the surgery: a perspective that may add to patient safety

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