Research Article|Articles in Press, 102320

Effect of non-mechanical bowel preparation on postoperative gastrointestinal recovery following surgery on malignant gynecological tumors: A randomized controlled trial

Published:March 11, 2023DOI:


      • In China, mechanical bowel preparation is the routine bowel preparation for preoperative surgery for gynecological malignancies. But non-MBP in cancer gynaecology surgery,there is no such recommendation due to lack of evidence.
      • We found that the Preoperative nonmechanical bowel preparation in patients with gynecological malignant tumors did not affect intraoperative visual field exposure, nor increase the incidence of intraoperative involuntary defecation and surgical injury to adjacent organs.
      • Besides, the postoperative recovery of intestinal function in patients undergoing nonmechanical bowel preparation before surgery was better than that in patients undergoing mechanical bowel preparation. And the incidence of postoperative gastrointestinal adverse reactions was lower in patients undergoing nonmechanical bowel preparation before surgery than in patients undergoing mechanical bowel preparation.
      • Thirdly, Patients undergoing gynecological malignant tumor surgery without mechanical bowel preparation had better medical comfort than patients undergoing mechanical bowel preparation.
      • Thus, Nonmechanical bowel preparation is safer andbetter choice for gynecological malignant tumor patients without intestinal metastasis than MBP.



      To investigate the efficacy and safety of non-mechanical bowel preparation (non-MBP) in patients undergoing surgery for malignant gynecological tumors.


      Patients undergoing surgery for a gynecological malignancy (n = 105) were randomized to receive mechanical bowel preparation (MBP) or non-MBP. Parameters indicating postoperative gastrointestinal function recovery were the primary outcomes. The secondary outcomes included the number of postoperative complaints, the plasma levels of D-lactate and diamine oxidase (DAO), ease of visualization of the surgical field, involuntary defecation during surgery, operation time, wound healing, surgical site infection, length of hospital stay, and tolerance to MBP.


      The participants in the non-MBP group exhibited shorter time intervals until the first postoperative bowel movement (27.87 vs. 29.48 h), first passage of flatus (50.96 vs. 55.08 h), and first passage of stool (75.94 vs. 98.50 h) compared with the MBP group, while they also exhibited fewer postoperative gastrointestinal symptoms, including nausea (18.9% vs. 38.5%), vomiting (26.4% vs. 51.9%), abdominal pain (34.0% vs. 78.9%), and bloating (3.8% vs.26.9%). The plasma D-lactate and DAO levels were significantly increased following bowel preparation compared with the baseline levels in the MBP group (2.93 vs. 5.68 nmol/mL and 20.46 vs. 54.49 ng/mL, respectively), but no such differences were observed in the non-MBP group. Compared with the MBP group, surgical field visualization was superior (92.45% vs. 78.85%), and the operation time was shorter (173.58 vs. 203.88 min) in the non-MBP group. The patients undergoing MBP complained of bloating (182.35%), an unpleasant taste (78.43%), sleep disturbance (70.59%), nausea (68.63%), abdominal pain (64.71%), vomiting (45.10%), polydipsia (33.33%), dizziness (25.49%), and headache (7.84%).


      The use of non-MBP in patients undergoing surgery for gynecological malignancies is more conducive to the postoperative recovery of gastrointestinal function.


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