Abstract
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.
Highlights
Bowel preparation (BP) before surgery traditionally refers to the removal of bowel contents via mechanical cleansing with oral or rectal mechanical measures
It is believed that mechanical bowel preparation (MBP) protects against complications, such as surgical site infections, anastomotic leakage, and fecal peritonitis by minimizing the fecal load of the bowel [6, 11, 12]
Some studies suggest that MBP could increase the risk of anastomotic leakage, due to bowel irritation caused by the laxatives [10]
Summary
Bowel preparation (BP) before surgery traditionally refers to the removal of bowel contents via mechanical cleansing with oral or rectal mechanical measures. Despite the fact that administration of preoperative bowel preparation has been a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence [1,2,3]. E proposed benefits from the use of bowel preparation include reduced rates of surgical site infections (SSI), easier manipulation of the bowel during surgery, and reduced rates of anastomotic leakage (AL) in case of bowel anastomosis [4, 5]. Despite the lack of supporting literature, mechanical bowel preparation (MBP) still represents an ingrained practice before gynecologic surgery as in other surgical specialties [5, 6]. Oral antibiotic bowel preparation (OABP), which constitutes another aspect of BP, has emerged during the last decades in order to address the need of further reducing patients’ postoperative morbidities and mortality. Supporters of MBP still suggest that an empty bowel results in a better surgical view and a less contaminated surgical field [4, 6,7,8,9,10,11,12]
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