To assess the efficacy and safety of mechanical bowel preparation before benign laparoscopic or vaginal gynecologic surgeries.
Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences as well as citations and reference lists published up to December 2021.
Randomized clinical trials in any language comparing mechanical bowel preparation with no preparation were included. Two reviewers independently screened 925 records and extracted data from 12 selected articles and assessed the risk of bias with the Rob2 tool. A random-effects model was used for the analysis. Surgeon findings (surgical field view, quality of bowel handling and bowel preparation), operative outcomes (blood loss, operative time, length of stay, surgical site infection) and patient’s pre-operative symptoms and satisfaction were collected.
Thirteen studies (1715 patients) assessing oral and rectal preparations before laparoscopic and vaginal gynecologic surgeries were included. No significant differences were observed with or without mechanical bowel preparation on surgical field view (primary outcome, risk ratio (RR) = 1.01, 95%CI 0.97 to 1.05, p=0.66, I=0%); bowel handling (RR = 1.01, 95%CI 0.95 to 1.08, p=0.78, I=67%) or bowel preparation. In addition, there were no statistically significant differences in peri-operative findings. Mechanical bowel preparation was associated with increased pain (mean difference (MD) 11.62[2.80 to 20.44], I=76, p=0.01); weakness (MD 10.73[0.60 to 20.87], I=94, p=0.04); hunger (MD 17.52[8.04 to 27.00], I=83, p=0.0003); insomnia (MD 10.13[0.57 to 19.68], I=82, p=0.04); and lower satisfaction (RR = 0.68 95%CI 0.53 to 0.87, I=76%, p=0.002), compared with controls.
Mechanical bowel preparation has not been associated with improved surgical field view, bowel handling or operative outcome. However, in view of the adverse effects induced, its routine use prior to benign gynecological surgeries should be abandoned. PROSPERO Registration: CRD42022296724.
Copyright © 2023. Published by Elsevier Inc.
