Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literat
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REVIEW
Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature Michail Diakosavvas1 · Nikolaos Thomakos1 · Dimitrios Haidopoulos1 · Michael Liontos2 · Alexandros Rodolakis1 Received: 10 September 2019 / Accepted: 25 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this review is to assess the impact of mechanical and oral antibiotics bowel preparation on surgical performance and to investigate their role before gynecologic surgical procedures regarding the infection rates. We also aim to study the updated evidence regarding the use of these different types of bowel preparation, as well as the current preoperative practice applied. Methods An extensive search of the literature was conducted with Medline/PubMed, and the Cochrane Library Database of Systematic Reviews being used for our primary search. Results To date, due to the conflicting guidelines by the scientific societies, surgeons do not use a specific pattern of bowel preparation regimen. There are no strong evidence supporting mechanical bowel preparation, but instead, in many cases, patients’ adverse effects, both physiological and psychological have been noted. On the other hand, the combined use of oral antibiotic and mechanical bowel preparation has been proven beneficial in colorectal surgery in reducing postoperative morbidities. Conclusion Based on current literature, in gynecologic surgeries with minimal probability of intraluminal entry, a regimen without any bowel preparation should be applied. The combined administration of both mechanical and oral antibiotic bowel preparation, or even the use of the oral antibiotics alone, should be preserved for cases of increased complexity, where bowel involvement is highly anticipated, such as in gynecologic oncology, as stated in the ERAS protocols. Nonetheless, further research specific to gynecologic surgery is required. Keywords Bowel preparation · Mechanical · Oral antibiotics · Gynecology · Surgical site infections
Introduction * Michail Diakosavvas [email protected] Nikolaos Thomakos [email protected] Dimitrios Haidopoulos [email protected] Michael Liontos [email protected] Alexandros Rodolakis [email protected] 1
Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
2
The use of preoperative Bowel Preparation (BP) is an accepted and ingrained practice in gynecology just like in other surgical specialties. Mechanical Bowel Preparation (MBP) has been administered to the surgical patients for over a century and is considered a common practice in surgery, despite the changes in the agents used over time [1–3]. The theoretical advanta
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