- •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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Oncology Nursing
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Preoperative mechanical and oral antibiotic bowel preparation to reduce infectious complications of colorectal surgery - the need for updated guidelines.J. Hosp. Infect. 2019; 101: 295-299
- Enhanced recovery after surgery (ERAS) in gynecology oncology.Eur. J. Surg. Oncol. : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2021; 47: 952-959
- Rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes postoperative gastrointestinal function recovery.World J. Gastroenterol. 2020; 26: 3271-3282
- & association of coloproctology of Great Britain and Ireland gastrointestinal recovery group.Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery’. BJS open. 2018; 3: 1-10
- Cervical cancer.Lancet (London, England). 2019; 393 (10167): 169-182
- Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature.Arch. Gynecol. Obstet. 2020; 302: 1049-1061
- Preoperative bowel preparation in minimally invasive and vaginal gynecologic surgery.TheScientificWorldJOURNAL. 2020; 20208546037
- Influence of gum chewing on postoperative bowel activity after complete staging surgery for gynecological malignancies: a randomized controlled trial.Gynecol. Oncol. 2013; 131: 118-122
- Non-invasive assessment of barrier integrity and function of the human gut.World J. Gastrointest. Surg. 2010; 2: 61-69
- Mechanical bowel preparation for elective colorectal surgery.The Cochrane database of systematic reviews. 2011; (2011): CD001544
- Survey on implementation of Enhanced Recovery after Surgery Guidelines among gynecologic patients in tertiary hospitals in China.Chin. J. Nurs. 2018; 53: 1084-1088
- A review of bowel preparation before colorectal surgery.Annal. Coloproctol. 2021; 37: 75-84
- Use of bowel preparation does not reduce postoperative infectious morbidity following minimally invasive or open hysterectomies.Am. J. Obstet. Gynecol. 2020; 223 (e1–231.e12): 231
- Clinical outcomes following mechanical plus oral antibiotic bowel preparation versus oral antibiotics alone in patients undergoing colorectal surgery.BJS open. 2018; 2: 238-245
- Mechanical bowel preparation before gynecologic laparoscopic procedures: is it time to abandon this practice?.’ The journal of obstetrics and gynaecology research. 2021; 47: 1487-1496
- Gastrointestinal recovery after surgery: protocol for a systematic review.BMJ Open. 2021; 11e054704
- A validated bowel-preparation tolerability questionnaire and assessment of three commonly used bowel-cleansing agents.Dig. Dis. Sci. 2013; 58: 926-935
- Epithelial ovarian cancer.Lancet (London, England). 2019; 393 (10177): 1240-1253
- Is preoperative bowel preparation necessary for gynecological oncology surgery?.Taiwan. J. Obstet. Gynecol. 2016; 55: 198-201
- Enhanced recovery after surgery: a review.JAMA Surg. 2017; 152: 292-298
- Survival after minimally invasive radical hysterectomy for early-stage cervical cancer.N. Engl. J. Med. 2018; 379: 1905-1914
- & clinical practice guidelines committee of the American society of colon and rectal surgeons.The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Use of Bowel Preparation in Elective Colon and Rectal Surgery’. Diseases of the colon and rectum. 2019; 62: 3-8
- Endometrial cancer.Lancet (London, England). 2016; 387: 1094-1108
- Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial.Fertil. Steril. 2006; 85: 689-693
- Guidelines for perioperative care in gynecologic/oncology: enhanced Recovery after Surgery (ERAS) Society recommendations-2019 update.Int. J. Gynecol. Cancer : official journal of the International Gynecological Cancer Society. 2019; 29: 651-668
- Recurrence and survival after laparoscopy versus laparotomy without lymphadenectomy in early-stage endometrial cancer: long-term outcomes of a randomised trial.Gynecol. Oncol. 2022; 164: 265-270
- Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis.World J. Gastroenterol. 2018; 24: 519-536
- Evaluating mechanical bowel preparation prior to total laparoscopic hysterectomy.J. Soc. Laparoendosc. Surg. : J. Soc. Laparoendosc. Surg. 2015; 19 (e2015.00035)
- The intestinal barrier and current techniques for the assessment of gut permeability.Cells. 2020; 9: 1909
- Sterility of selected operative sites during total laparoscopic hysterectomy.J. Minim. Invasive Gynecol. 2017; 24: 990-997
- Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery: a randomized controlled trial.Obstet. Gynecol. 2013; 121: 538-546
Accepted: March 10, 2023
Received in revised form: February 27, 2023
Received: December 11, 2022
Publication stageIn Press Accepted Manuscript
© 2023 Published by Elsevier Ltd.