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Tuesday, February 19, 2013

Trailers (43): Mechanical bowel prep before laparoscopic gyn surgery

Won, et al. Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery: a randomized controlled trial

Why should you read about this topic?

Gynecologists who have personally experienced a mechanical bowel prep want to be absolutely sure it is helpful before subjecting our patients to it preoperatively

What were the authors trying to do?

To determine if a mechanical bowel prep improves the surgical view and bowel handling during laparoscopic gynecologic surgery

Who participated and in what setting?

Women (N=257) 18-80 years of age undergoing laparoscopic gynecologic surgery for benign disease at the Royal Hospital for Women or the Prince of Wales Private Hospital (Sydney, Australia) between 2008-2011

What was the study design?

Randomized, single-masked (evaluators) trial with three arms: fasting only, minimal residue diet plus fasting, and mechanical bowel prep (sodium picosulfate) plus minimal residue diet plus fasting

What were the main outcome measures?

Visual analog scale (VAS) for intraoperative surgical view and bowel handling

What were the results?

Although the mechanical bowel prep group had better VAS scores than the minimal residue diet or fasting groups for surgical view and bowel handling, the differences were narrow and unlikely to be clinically significant.  Further, women with mechanical bowel preps and/or minimal residue diets were more likely to have headaches, thirst, weakness, tiredness, anxiety and discomfort than women who only fasted.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: randomized controlled trial. Weaknesses: probably not masked, despite the authors’ efforts; VAS for the main outcome measures not standardized or validated; not powered for surgical complications; analyzed per-protocol, not intention-to-treat; participants were ideal surgical candidates (young age, desirable BMI, little prior surgery)

What does the study contribute for your practice?

For your patients undergoing laparoscopy for benign gynecologic conditions, it’s probably not worth their aggravation to endure a low residue diet or mechanical bowel prep preoperatively.