Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has\nbeen a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence.\nMechanical bowel preparation in minimally invasive and vaginal gynecologic surgery is strongly debated, since many studies\nhave not confirmed its effectiveness, neither in reducing postoperative infectious morbidity nor in improving surgeonsâ??\nperformance. A comprehensive search of Medline/PubMed and the Cochrane Library Database was conducted, for related\narticles up to June 2019, including terms such as â??mechanical bowel preparation,â? â??vaginal surgery,â? â??minimally invasive,â? and\nâ??gynecology.â? We aimed to determine the best practice regarding bowel preparation before these surgical approaches. In\nprevious studies, bowel preparation was evaluated only via mechanical measures. The identified randomized trials in laparoscopic\napproach and in vaginal surgery were 8 and 4, respectively. Most of them compare different types of preparation, with\npatients being separated into groups of oral laxatives, rectal measures (enema), low residue diet, and fasting. The outcomes of\ninterest are the quality of the surgical field, postoperative infectious complications, length of hospital stay, and patientsâ??\ncomfort during the whole procedure. The results are almost identical regardless of the procedureâ??s type. Routine administration\nof bowel preparation seems to offer no advantage to any of the objectives mentioned above. Taking into consideration the fact\nthat in most gynecologic cases there is minimal probability of bowel intraluminal entry and, thus, low surgical site infection\nrates, most scientific societies have issued guidelines against the use of any bowel preparation regimen before laparoscopic or\nvaginal surgery. Nonetheless, surgeons still do not use a specific pattern and continue ordering them. However, according to\nrecent evidence, preoperative bowel preparation of any type should be omitted prior to minimally invasive and vaginal\ngynecologic surgeries.
Loading....