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Two Bowel Preps for Gyn. Laparoscopy Are Comparable in Surgeon's View


 

From the Annual Meeting of the American Society for Reproductive Medicine

Major Finding: Surgeons rated the quality of the visual field as good or excellent 85% of the time when the oral preparation was used and, similarly, 91% of the time with the enema.

Data Source: A single-center prospective study in which 145 women undergoing gynecologic laparoscopic surgery were randomized to oral sodium phosphate solution or a sodium phosphate enema as bowel preparation.

Disclosures: Dr. Yang declared she has no relevant financial interests.

DENVER – The use of oral sodium phosphate solution for mechanical bowel preparation in gynecologic laparoscopy doesn't provide a better-quality visual field than does a single sodium phosphate enema – and patients much prefer the enema, according to randomized trial results.

On balance, the enema may be the better regimen for gynecologic laparoscopic surgeries, as it causes significantly fewer side effects. And as the study demonstrated, surgeons can't tell the difference between the oral solution and enema in terms of surgical field visualization, Dr. Linda C. Yang said.

Mechanical bowel preparation was embraced by general surgeons several decades ago in a belief that a decreased fecal load at the time of surgery would mean fewer infectious complications. However, recent published trials in colorectal surgery have not shown a significant benefit. And while mechanical bowel preparation is popular among gynecologic laparoscopic surgeons, its pros and cons in the context of this highly specialized form of surgery have not previously been well defined, observed Dr. Yang of Beth Israel Deaconess Medical Center, Boston.

This was the impetus for her single-center prospective study in which 145 women undergoing gynecologic laparoscopic surgery were randomized to oral sodium phosphate solution or a sodium phosphate enema. Surgeons were blinded as to patient allocation assignment.

The primary study end point was the visual quality of the surgical field at the beginning and conclusion of the operation as assessed by the surgeons, who completed a detailed same-day questionnaire. They rated the quality of the visual field as good or excellent 85% of the time when the oral preparation was used and, similarly, 91% of the time with the enema. There were no significant differences between the two groups in terms of surgeons' ratings of need for additional maneuvers to enhance exposure, degree of difficulty in bowel manipulation using laparoscopic instruments, surgical difficulty, or ability to visualize the uterus, right and left adnexal structures, and posterior cul-de-sac.

Surgeons were able to accurately predict which group their patients were in only 52% of the time: “Essentially, a flip of the coin,” Dr. Yang noted.

Patients self-rated the severity of 12 symptoms on a visual analog scale. The oral sodium phosphate group characterized six symptoms as significantly more severe: abdominal bloating, thirst, weakness, dizziness, nausea, and fecal incontinence. Severity of the other six symptoms was not significantly different between the two groups. Two-thirds of the enema group rated their bowel preparation as easy. That was the case for 26% of those in the oral preparation group.

Ninety-seven percent of patients in the enema group said they would be willing to do the same preparation again, compared with 44% of patients in the oral preparation group.

The enema causes significantly fewer side effects.

Source DR. YANG

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