Safety And Feasibility Of Modified Preoperative Bowel Preparation For Women Undergoing Laparoscopic Gynecological Surgery

ObjectivesTo explore the safety of modified preoperative bowel preparation for women undergoing laparoscopic gynecologic surgery so as to reduce physical and psychological impact on patients, promote postoperative rehabilitation and update current preoperative bowel preparation protocol.MethodsAccording to inclusion criteria, a total of427women who underwent gynecological laparoscopic surgery from March2014to February2015, in Women’s Hospital School of Medicine Zhejiang University, were invited to participated in the study. After informed consent, enrolled women were randomly assigned to either the control group (n=225) or to the observation group (n=202). The observation group should have a low fiber diet on the day before operation, fasting8hours and nil by mouth4hours preoperatively. While on the basis of low fiber diet on the day before operation, the control group routinly took liquid(polyethylene glycol electrolyte powder) orally to cleanse intestinal tract in the afternoon of the day before surgery, and then fasting8hours and nil by mouth4hours preoperatively. Surgical field exposure, bleeding volume, involuntary defecation during operation,gastrointestinal symptoms and bowel function postoperatively, urineacetone (KET), the time of operation and hospital stay after operation were evaluated for women in both groups. The feeling and tolerance of oral cleansing liquid were also assessed for women in the control group.ResultsFirstly, the results of observation group and control group during surgery were as follows. The percentage of surgeons satisfied with intra-operative surgical field exposure was83.7%in the observation group and76.4%in the control group, and there was no significant difference between the two groups (P=0.166). There was no involuntary defecation occurring during surgery in observation group, while2.2%patients in the control group experienced involuntary defecation, and the difference between the two groups was not statistically significant (P=0.093). No intra-operative organ damage occurred in both groups. The mean blood loss during surgery was37.7ml in the observation group,39.6ml in the control group, and the difference was not statistically significant (P=0.469).Secondly, the results of observation group and control group after surgery were as follows. No postoperative intestinal obstruction happened in observation and control groups. The incidence of nausea and vomiting after surgery was4.5%and6.4%respectively, and the corresponding incidence in observation group was9.8%and13.3%, the differences were statistically significant between the two groups(P=0.034, P=0.018). There was no moderate or severe abdominal distension occurs in two groups.2.5%patients in observation group had mild abdominal distension, and6.2%in control group, the difference between them was statistically significant (P=0.061). The occurrence of diarrhea was1.0%in the observation group, compared with10.2%in the control group, the difference was statistically significant (P<0.001). The incidence of KET evaluated as (++) and (+++) was16.3%and6.4%in the observation group, which was significantly lower than the control group, compared with27.6%and15.1%(P<0.001). The first time of peristalsis, anal aerofluxus, defecation and the average length of stay of patients in observation group were15.1hours,18.2hours,41.77hours and5.46days, shorter than those in control group, whose respective time were17.4hours,21.2hours,49.9hours and6.76days, and the differences were statistically significant (P<0.001).Finally, drug tolerance of oral cleansing liquid in control group was as follows:About91.1%of the patients had different degrees of unpleasant taste.93.3%and88.9%of patients had abdominal distension and abdominal pain accordingly.64.4%and40.0%of patients had nausea and vomit.54.7%of the patients had sleep disorders.27.6%and31.6%of the patients had a very mild and slight polydipsia.21.3%of patients felt dizzy and15.6%of patients had a headache.ConclusionsModified preoperative bowel preparation, the model of a low fiber diet on the day before operation followed by fasting8hours and nil by mouth4hours preoperatively, could improve surgical field exposure, reduce bleeding and avoid involuntary defecation and organ injury during operation. Also, it could alleviate the gastrointestinal symptoms, quicken recovery of bowell function and other concurrency diseases oafter operation. Besides, possible adverse reactions due to cleansing liquid could be avoided and patient experience of hospital stay could be optimised since no cleansing liquid needed in modified bowel preparation model. Therefore, modified preoperative bowel preparation for women andergoing laparoscopic gynecological abdominal surgery is safe and feasible.