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Debate 1B - Should Routine Mechanical Bowel Preparation be Performed before Primary Debulking Surgery?

No

from Section I - Perioperative Management

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Given the limited data on the value of mechanical bowel preparation (MBP) prior to gynecologic surgery, the colorectal data is frequently extrapolated and used to guide preoperative management for patients requiring bowel surgery. Review of the colorectal literature, including a Cochrane Review and large National Surgery Quality Improvement Program database review, demonstrates that the use of MBP does not improve overall mortality, surgical site infection, anastomotic leak rates, or reoperation. As a result, several national and international surgical organizations do not support the use of MBP alone prior to bowel surgery including patients planning gynecologic surgery.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Nelson, G, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations – 2019 update. Int J Gynecol Cancer 2019;29(4):651668. https://doi.org/10.1136/ijgc-2019-000356CrossRefGoogle ScholarPubMed
Güenaga, KF, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011;9:CD001544. https://doi.org/10.1002/14651858.CD001544.pub4CrossRefGoogle Scholar
Koller, SE, et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 2018;267(4):734742. https://doi.org/10.1097/SLA.0000000000002159CrossRefGoogle ScholarPubMed
Migaly, J, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Use of Bowel Preparation in Elective Colon and Rectal Surgery. Dis Colon Rectum 2019;62(1):38. https://doi.org/10.1097/dcr.0000000000001238CrossRefGoogle ScholarPubMed
Kalogera, E, et al. Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Am J Obstet Gynecol 2018;219(6):563.e561–563.e519. https://doi.org/10.1016/j.ajog.2018.07.014CrossRefGoogle ScholarPubMed

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