Highlights
- •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.
Abstract
Objective
To investigate the efficacy and safety of non-mechanical bowel preparation (non-MBP)
in patients undergoing surgery for malignant gynecological tumors.
Methods
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.
Results
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%).
Conclusions
The use of non-MBP in patients undergoing surgery for gynecological malignancies is
more conducive to the postoperative recovery of gastrointestinal function.
Keywords
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Article info
Publication history
Accepted:
March 10,
2023
Received in revised form:
February 27,
2023
Received:
December 11,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Published by Elsevier Ltd.
