Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review

Arnold, Amy; Aitchison, Lucy P.; Abbott, Jason

doi:10.1016/j.jmig.2015.04.003

Cited by 48 publications

(16 citation statements)

References 88 publications

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“…Many metaanalysis and reviews have been published regarding MBP's efficacy and its possible side effects. Most authors set as a primary outcome of interest the quality of the surgical field, postoperative complications, and patients' comfort during the whole procedure, but they also set secondary objectives like length of hospital stay (LOS) and economic costs [23].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

Diakosavvas

Thomakos

Psarris

et al. 2020

The Scientific World Journal

View full text Add to dashboard Cite

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“…A systemic review of five randomised controlled trials for gynaecological surgery also did not show any benefits but reported an unpleasant patient experience. Its use in gynaecological laparoscopic surgery did not improve operative time or surgical field visualisation 23 .…”

Section: Bowel Preparationmentioning

confidence: 93%

Enhanced recovery for gynaecological surgery: a review

Yim

Lam

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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We review various aspects of enhanced recovery after surgery for gynaecological patients, including patient education and counselling, preoperative assessment and optimisation, preoperative fasting and nutrition, bowel preparation, thromboembolism prophylaxis, perioperative analgesia, peritoneal drains and urinary catheters, postoperative nausea and vomiting, hypothermia prevention, early feeding and early mobilisation, and implementation of enhanced recovery after surgery.

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“…However, patients undergoing bowel preparation did experience increased patient discomfort. 68,70,71 The authors conclude that rectal enemas and mechanical bowel preparations can safely be abandoned in gynecologic surgery. 70 For surgery with a planned bowel resection a recent t meta-analysis suggests that mechanical bowel preparation along with antibiotics may decrease rates of postoperative infectious complications.…”

Section: Important Components Of Erpmentioning

confidence: 99%

“…68,70,71 The authors conclude that rectal enemas and mechanical bowel preparations can safely be abandoned in gynecologic surgery. 70 For surgery with a planned bowel resection a recent t meta-analysis suggests that mechanical bowel preparation along with antibiotics may decrease rates of postoperative infectious complications. However, for mechanical bowel preparation alone, a Cochrane review of 18 RCTs found that there was no significant difference between anastomotic leak rates and infectious morbidity among patients undergoing bowel preparation or rectal enemas when compared with no preparation.…”

Section: Important Components Of Erpmentioning

confidence: 99%

Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

Barber

2015

Obstetrical &Amp; Gynecological Survey

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Importance Enhanced recovery programs (ERPs) are considered standard of care across a variety of surgical disciplines, but ERPs have not been widely adopted in gynecology. Objective To describe ERP principles and the role of ERPs in gynecology and gynecologic oncology. Evidence Acquisition Comprehensive literature search performed using MEDLINE, the Cochrane Collaboration Database, and PubMed. Results Meta-analyses of a substantial number of randomized-controlled trials have shown that implementation of ERP protocols is associated with decreased length of hospital stay, a decrease in rates of postoperative complication, decreased morbidity, and cost savings while preserving patient satisfaction and quality of life. Conclusions and Relevance High quality evidence exists for improved outcomes among patients in ERPs. ERPs save resources and costs across the health care system. As quality metrics and bundled payments increase in healthcare, ERPs will have increasing prominence.

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Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review

Cited by 48 publications

References 88 publications

Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery

Enhanced recovery for gynaecological surgery: a review

Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

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