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The Use of Mechanical Bowel Preparation in Pelvic Reconstructive Surgery: A Randomized Controlled Trial

Adelowo, Amos O. MD, MPH; Hacker, Michele R. ScD; Modest, Anna M. MPH; Apostolis, Costa A. MD; Disciullo, Anthony J. MD; Hanaway, Katherine J. MD; Elkadry, Eman E. MD; Rosenblatt, Peter L. MD; Rogers, Kathleen J.; Hota, Lekha S. MD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2017 - Volume 23 - Issue 1 - p 1–7
doi: 10.1097/SPV.0000000000000346
Original Articles
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Objective To compare mechanical bowel preparation (MBP) using oral magnesium citrate with sodium phosphate enema to sodium phosphate (NaP) enema alone during minimally invasive pelvic reconstructive surgery.

Methods We conducted a single-blind, randomized controlled trial of MBP versus NaP in women undergoing minimally invasive pelvic reconstructive surgery. The primary outcome was intraoperative quality of the surgical field. Secondary outcomes included surgeon assessment of bowel handling and patient-reported tolerability symptoms.

Results One hundred fifty-three participants were enrolled; 148 completed the study (71 MBP and 77 NaP). Patient demographics, clinical and intraoperative characteristics were similar. Completion of assigned bowel preparation was similar between MBP (97.2%) and NaP (97.4%). The MBP group found the preparation more difficult (P<0.01) and reported more overall discomfort and negative preoperative side effects (all P≤0.01). Quality of surgical field at initial port placement was excellent/good in 80.0% of the MBP group compared with 62.3% in the NaP group (P=0.02). This difference was not maintained by the conclusion of surgery (P=0.18). Similar results were seen in the intent-to-treat population. Surgeons accurately guessed preparation 65.7% of the time for MBP versus 41.6% for NaP (P=0.36). At 2 weeks postoperatively, both reported a median time for return of bowel function of 3.0 (2.0–4.0) days.

Conclusions Mechanical bowel preparation with oral magnesium citrate before minimally invasive pelvic reconstructive surgery offered initial improvement in the quality of surgical field, but this benefit was not sustained. It was associated with an increase in patient discomfort preoperatively, but did not seem to impact postoperative return of bowel function.

LEVEL OF EVIDENCE I

Mechanical bowel preparation with oral magnesium citrate saline laxative offered no added advantage in quality of surgical field, perioperative complication, or length of hospitalization when compared with sodium phosphate enema alone.

From the *Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston; †Department of Obstetrics and Gynecology, Reliant Medical Group, Worcester; ‡Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston; §Department of Obstetrics and Gynecology, Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA

Reprints: Lekha Hota MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Boston Urogynecology Associates, 725 Concord Avenue, Suite 1200, Cambridge MA 02138. E-mail: lhota@mah.harvard.edu.

The authors have declared they have no conflicts of interest.

Financial Support: This project was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (NIH Award UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers).

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, Clinical Trial NCT01522261

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