Vaginal prolapse surgery no bowel prep needed

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January 20, 2014
Mechanical bowel preparation before reconstructive vaginal prolapse surgery offers no advantages and makes patients unhappy,
according to a randomized controlled trial published online January 7 in Obstetrics & Gynecology.
To determine the effect of mechanical bowel preparation, Alicia C. Ballard, MD, from the Urogynecology Care Clinic at the
University of Alabama at Birmingham, and colleagues randomly assigned 150 women either to a clear diet and 2 self-administered
saline enemas on the day before surgery (n = 75) or to continuation of a regular diet (n = 75). Both groups were told to abstain
from anything by mouth after midnight the night before surgery. Surgeons were blinded to the patients' assignment.
A similarly high percentage of surgeons in both groups gave the intraoperative field top marks, rating bowel cleansing as "excellent
or good" (85% in the intervention group vs 90% in the control group; odds ratio [OR], 0.59; 95% confidence interval [CI], 0.21 -
1.61; P = .30).
In addition, surgeons' intraoperative assessment of the rectal vault revealed no differences between groups in the presence of gas
or stool; both had adequate visualization and similar intraoperative stooling and difficulty of bowel handling (P > .05 for all).
The only real difference between groups was patient satisfaction.
The 2 patient groups had similar demographic, clinical, and intraoperative characteristics (P > .05); however, the women assigned
to receive bowel prep were significantly less likely to report complete satisfaction compared with those in the control group (OR,
0.11; 95% CI, 0.04 - 0.35; P < .001).
Complaints included hunger pains (1.09 ± 1.13 vs no bowel prep, 0.27 ± 0.73; P < .001), abdominal cramps or pain (0.99 ± 1.35 vs
0.35 ± 0.91; P < .001), and abdominal fullness and bloating (0.81 ± 1.08 vs 0.31 ± 0.77; P < .001). In addition, 3 women (4%)
found administering saline enemas to be "distressing."
Although the study is limited by its single-site design, its strength lies in the field assessments by 4 experienced, high-volume
vaginal surgeons.
"This is certainly an important finding," Michael Safir, MD, from the Southern California Center for Advanced Urology in West Hills,
told Medscape Medical News. "I'm happy that the study addresses the most unpleasant aspect of the patient's preparation for
prolapse surgery. The results of the study suggest the surgery is no more difficult in patients without bowel prep and that it may
reduce bowel symptoms after surgery."
Dr. Safir, who specializes in the field of reconstructive urology, noted, however, that although the incidence of rectal injury after
prolapse repair is low, a bowel prep may reduce the risk for fecal soiling, possibly facilitating the repair of this rare event.
The authors point out that their results are in line with studies in both elective colorectal surgery and laparoscopic gynecologic
surgery. In those areas, many surgeons no longer require patients to undergo mechanical bowel preparation before surgery.
"[R]outine use of mechanical bowel preparation for reconstructive vaginal prolapse surgery should be reconsidered by all pelvic
floor surgeons," the authors conclude.
The study was supported in part by a grant from the UAB Center for Clinical and Translational Science, the National Center for
Advancing Translational Sciences, the National Center for Research Resources, the National Institute of Diabetes and Digestive
and Kidney Disease, and the National Institutes of Health. One coauthor has received research grants from Astellas, Pelvalon, and
the University of California San Francisco/Pfizer and has served as a consultant for Pelvalon and Astellas. The other authors have
disclosed no relevant financial relationships. Dr. Safir is a consultant for Coloplast.
Obstet Gynecol. Published online January 7, 2014. Abstract
Vaginal Prolapse Surgery: No Bowel Prep Needed
Yael Waknine

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Cite this article: Vaginal Prolapse Surgery: No Bowel Prep Needed. Medscape. Jan 20, 2014.