Reduction of Postoperative Gastrointestinal Dysmotility Following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

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Study Objective To assess the effect of common bowel care regimens on return of bowel function following total laparoscopic hysterectomy (TLH). Design A prospective three-arm randomized controlled trial (Canadian Task Force Classification I). Setting Single academic-affiliated institution. Patients or Participants Women aged 18-85 years, without preexisting gastrointestinal disorders, undergoing TLH for benign indications. Interventions Patients were randomized to one of three arms using an equal allocation ratio to receive either no bowel care regimen (control group), docusate sodium, or polyethylene glycol 3350 (PEG) for the first five days following surgery. The primary outcome was time to first bowel movement postoperatively. Secondary outcomes were time to first flatus, total narcotic use in the first five days postoperatively, constipation score, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire score. Measurements and Main Results There were no significant differences in time to first bowel movement postoperatively amongst those receiving no bowel care regimen, docusate sodium, or PEG (2.64 ± 1.19, 2.80 ± 1.08, 3.06 ± 1.18 days; p=0.436). Similarly, there were no significant differences in time to first flatus: 1.06 days (interquartile range 0.89-1.70) in the control group, 1.05 days (interquartile range 0.78-1.37) in the docusate sodium group, and 1.11 days (interquartile range 0.82-1.40) in the PEG group (p=0.975). Total narcotic use in the first five days postoperatively, constipation score, and the PAC-SYM score did not vary significantly amongst the groups. Body mass index (BMI) was a significant predictor of time to first bowel movement with an increased BMI associated with a shorter time to first bowel movement [HR 1.05 (1.01, 1.10); p=0.013]. Conclusion In those undergoing laparoscopic hysterectomy for benign indications without any preexisting gastrointestinal disorders, the prescription of a bowel care medication does not significantly affect return of bowel function.