Surgical and Patient Outcomes Using Mechanical Bowel Preparation Before Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial

Won, HaRyun FRANZCOG; Maley, Peta BSc (Med); Salim, Stephanie BSc (Med); Rao, Archana FRANZCOG; Campbell, Neil T. FRANZCOG; Abbott, Jason A. PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e318282ed92
Original Research
Journal Club
Abstract

OBJECTIVE: Mechanical bowel preparation is a common practice before laparoscopic gynecologic surgery. This study aims to evaluate its capacity to improve surgical view and bowel handling in the deep pelvis.

METHODS: A single-blinded, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients assigned to one of the following three groups: fasting only; minimal residue diet for 2 days; or minimal residue diet for 2 days plus mechanical bowel preparation with oral sodium picosulphate. Outcomes included intraoperative surgical view and bowel handling, preoperative patient symptomatology, hematologic and biochemical characteristics, and bowel function.

RESULTS: Three hundred eight participants were randomized. The intraoperative surgical view and bowel handling was minimally but statistically better in the minimal residue plus mechanical bowel preparation group compared with the other groups with less than a 1-point difference on a 10-point visual analog scale (P<.01 and P<.04, respectively). Women were assessed at baseline and on the day of surgery for the difference in visual analog scale score in the fasting only, minimal residue diet, and minimal residue diet with mechanical bowel preparation groups for headache (2.2 compared with 10.5 compared with 21; P<.01), thirst (14.7 compared with 24.7 compared with 30.9; P<.01), weakness (−0.2 compared with 16.6 compared with 25; P<.01), tiredness (−4.5 compared with 8.1 compared with 15.4; P<.01), anxiety (12.5 compared with 10.1 compared with 10.3; P=.66), and discomfort (−8.2 compared with 8.7 compared with 6.6; P<.01), respectively. Hematologic parameters were not different among the groups, and there was no significant difference in bowel function between the groups.

CONCLUSION: Minimal residue diet plus mechanical bowel preparation provides statistical improvement in surgical view and bowel handling, but the benefit is likely of little clinical significance given overall blinded ratings from surgeons. Given the significant symptoms and discomfort caused for patients undertaking minimal residue diet with or without mechanical bowel preparation, fasting only without any preoperative diet or bowel preparation is a preferable alternative for laparoscopic gynecologic surgery involving the posterior pelvic compartment.

CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, www.anzctr.org.au, 12611000494932.

LEVEL OF EVIDENCE: I

In Brief

Mechanical bowel preparation before laparoscopic gynecologic surgery causes significant symptoms and discomfort for patients with little improvement in intraoperative bowel handling and surgical view.

Author Information

Royal Hospital for Women and the University of New South Wales, Sydney, Australia.

Corresponding author: Dr. HaRyun Won, The Royal Hospital for Women, Barker St, Randwick, New South Wales, 2031, Australia; e-mail: Haryun.Won@sesiahs.health.nsw.gov.au.

Supported in part by a research grant from the Australasian Gynaecological Endoscopic Surgery Society Limited (AGES).

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Karen Chan, Anvita Verma, Pallavi Kumar, Yvonne Paul, and Carolyn Woodhead for their contribution to data collection.

© 2013 The American College of Obstetricians and Gynecologists