CHARLESTON, S.C. – Mechanical bowel preparation prior to vaginal pelvic organ prolapse surgery offers no advantage over lack of any bowel preparation, with respect to surgeons’ assessment of acceptability, according to findings from a single-blind randomized trial involving 150 women.
Furthermore, the use of mechanical bowel preparation prior to surgery was associated with decreased patient satisfaction, Dr. Alicia C. Ballard reported at the annual meeting of the Society of Gynecologic Surgeons.
Surgeons’ acceptability, based on a rating of excellent or good in terms of bowel cleansing, was similar at 81.3% and 88% for 75 patients who underwent mechanical bowel preparation and 75 control subjects who received no bowel preparation. There also were no significant differences between the groups in intraoperative visualization, stooling, or difficulty in bowel handling, said Dr. Ballard of the University of Alabama at Birmingham.
Patient satisfaction was 61.3% in the bowel preparation group, compared with 89.3% in the control group. Patients in the bowel preparation group also were more likely to be willing to try a different form of bowel preparation (84.3% vs. 64.4%), she noted.
Study subjects were adult women scheduled to undergo vaginal prolapse surgery – with a planned apical suspension and posterior colporrhaphy – at a single center between January 2011 and August 2012. Those randomized to the intervention group were placed on a clear-liquid diet and administered saline enemas at 4 p.m. and 6 p.m. on the day prior to surgery. Those assigned to the control group continued on their regular diet. Both groups were instructed to take nothing by mouth after 12 a.m. on the day of the surgery.
The four participating surgeons were blinded as to patient allocation, and rated their acceptability of the bowel preparation using a 4-point Likert scale.
"Overall, surgeons assessed the bowel to be acceptably cleansed [excellent or good rating], with no differences noted between the intervention and control groups," Dr. Ballard said at the meeting, which was jointly sponsored by the American College of Surgeons.
In fact, bowel cleansing was assessed as "fair" or "poor" in more patients in the intervention group than the control group (14.7% vs. 9.3%), although this difference was not statistically significant.
Also, intraoperative assessment of the rectal vault showed no differences between the groups in the presence of gas or stool.
The findings are important given that 5 million women underwent prolapse procedures in the United States between 1976 and 2006, and that mechanical bowel preparation is commonly applied preoperatively - despite a lack of clear evidence that it is necessary or beneficial, Dr. Ballard said.
Although limited by the single-site design, this study has several strengths, including a robust sample size, randomization, and a well-defined surgical cohort that included patients undergoing concomitant apical suspension and posterior repair. It is also strengthened by the inclusion of both surgeon and patient assessments.
Therefore, the findings challenge the role of mechanical bowel preparation for vaginal prolapse surgery.
"Routine use of mechanical bowel preparation should be reconsidered," Dr. Ballard concluded.
She reported having no relevant financial disclosures.