Royal Hospital for Women and the University of New South Wales, Sydney, Australia.
Obstet Gynecol. 2013 Mar;121(3):538-546. doi: 10.1097/AOG.0b013e318282ed92.
Mechanical bowel preparation is a common practice before laparoscopic gynecologic surgery. This study aims to evaluate its capacity to improve surgical view and bowel handling in the deep pelvis.
A single-blinded, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients assigned to one of the following three groups: fasting only; minimal residue diet for 2 days; or minimal residue diet for 2 days plus mechanical bowel preparation with oral sodium picosulphate. Outcomes included intraoperative surgical view and bowel handling, preoperative patient symptomatology, hematologic and biochemical characteristics, and bowel function.
Three hundred eight participants were randomized. The intraoperative surgical view and bowel handling was minimally but statistically better in the minimal residue plus mechanical bowel preparation group compared with the other groups with less than a 1-point difference on a 10-point visual analog scale (P<.01 and P<.04, respectively). Women were assessed at baseline and on the day of surgery for the difference in visual analog scale score in the fasting only, minimal residue diet, and minimal residue diet with mechanical bowel preparation groups for headache (2.2 compared with 10.5 compared with 21; P<.01), thirst (14.7 compared with 24.7 compared with 30.9; P<.01), weakness (-0.2 compared with 16.6 compared with 25; P<.01), tiredness (-4.5 compared with 8.1 compared with 15.4; P<.01), anxiety (12.5 compared with 10.1 compared with 10.3; P=.66), and discomfort (-8.2 compared with 8.7 compared with 6.6; P<.01), respectively. Hematologic parameters were not different among the groups, and there was no significant difference in bowel function between the groups.
Minimal residue diet plus mechanical bowel preparation provides statistical improvement in surgical view and bowel handling, but the benefit is likely of little clinical significance given overall blinded ratings from surgeons. Given the significant symptoms and discomfort caused for patients undertaking minimal residue diet with or without mechanical bowel preparation, fasting only without any preoperative diet or bowel preparation is a preferable alternative for laparoscopic gynecologic surgery involving the posterior pelvic compartment.
机械性肠道准备是腹腔镜妇科手术前的常见做法。本研究旨在评估其在深部盆腔中改善手术视野和肠道处理的能力。
进行了一项单盲、随机、对照试验，将腹腔镜妇科手术患者分为以下三组之一：仅禁食；禁食 2 天加低渣饮食；禁食 2 天加低渣饮食加口服匹可硫酸钠机械性肠道准备。结果包括术中手术视野和肠道处理、术前患者症状、血液学和生化特征以及肠道功能。
308 名参与者被随机分组。与其他两组相比，低渣加机械性肠道准备组的术中手术视野和肠道处理仅略有改善，但统计学上有显著差异，视觉模拟评分相差不到 1 分（分别为 P<.01 和 P<.04）。女性在基线和手术当天接受视觉模拟评分评估，以评估仅禁食、低渣饮食和低渣饮食加机械性肠道准备组的头痛（2.2 与 10.5 与 21；P<.01）、口渴（14.7 与 24.7 与 30.9；P<.01）、虚弱（-0.2 与 16.6 与 25；P<.01）、疲倦（-4.5 与 8.1 与 15.4；P<.01）、焦虑（12.5 与 10.1 与 10.3；P=.66）和不适（-8.2 与 8.7 与 6.6；P<.01）的差异。各组的血液学参数无差异，各组的肠道功能无显著差异。
低渣饮食加机械性肠道准备可显著改善手术视野和肠道处理，但考虑到外科医生的总体盲法评分，其获益可能具有临床意义较小。鉴于接受低渣饮食加或不加机械性肠道准备的患者会出现明显的症状和不适，对于涉及后盆腔的腹腔镜妇科手术，仅禁食而无需任何术前饮食或肠道准备是一种更可取的选择。
