Diakosavvas Michail, Thomakos Nikolaos, Psarris Alexandros, Fasoulakis Zacharias, Theodora Marianna, Haidopoulos Dimitrios, Rodolakis Alexandros
1st Department of Obstetrics and Gynaecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
ScientificWorldJournal. 2020 Feb 14;2020:8546037. doi: 10.1155/2020/8546037. eCollection 2020.
Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has been a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence. Mechanical bowel preparation in minimally invasive and vaginal gynecologic surgery is strongly debated, since many studies have not confirmed its effectiveness, neither in reducing postoperative infectious morbidity nor in improving surgeons' performance. A comprehensive search of Medline/PubMed and the Cochrane Library Database was conducted, for related articles up to June 2019, including terms such as "mechanical bowel preparation," "vaginal surgery," "minimally invasive," and "gynecology." We aimed to determine the best practice regarding bowel preparation before these surgical approaches. In previous studies, bowel preparation was evaluated only via mechanical measures. The identified randomized trials in laparoscopic approach and in vaginal surgery were 8 and 4, respectively. Most of them compare different types of preparation, with patients being separated into groups of oral laxatives, rectal measures (enema), low residue diet, and fasting. The outcomes of interest are the quality of the surgical field, postoperative infectious complications, length of hospital stay, and patients' comfort during the whole procedure. The results are almost identical regardless of the procedure's type. Routine administration of bowel preparation seems to offer no advantage to any of the objectives mentioned above. Taking into consideration the fact that in most gynecologic cases there is minimal probability of bowel intraluminal entry and, thus, low surgical site infection rates, most scientific societies have issued guidelines against the use of any bowel preparation regimen before laparoscopic or vaginal surgery. Nonetheless, surgeons still do not use a specific pattern and continue ordering them. However, according to recent evidence, preoperative bowel preparation of any type should be omitted prior to minimally invasive and vaginal gynecologic surgeries.
传统上，肠道准备是指通过机械清洁措施清除肠道内容物。尽管这一做法已沿用70多年，但它的应用大多基于专家意见，而非确凿证据。在微创和阴道妇科手术中，机械肠道准备存在很大争议，因为许多研究既未证实其在降低术后感染发病率方面的有效性，也未证实其在改善外科医生操作方面的有效性。我们对Medline/PubMed和考克兰图书馆数据库进行了全面检索，以查找截至2019年6月的相关文章，检索词包括“机械肠道准备”“阴道手术”“微创”和“妇科”。我们旨在确定这些手术方式前肠道准备的最佳做法。在以往研究中，肠道准备仅通过机械措施进行评估。在腹腔镜手术和阴道手术中确定的随机试验分别为8项和4项。其中大多数比较了不同类型的准备方法，将患者分为口服泻药组、直肠措施（灌肠）组、低残留饮食组和禁食组。关注的结果包括手术视野质量、术后感染并发症、住院时间以及患者在整个手术过程中的舒适度。无论手术类型如何，结果几乎相同。常规进行肠道准备似乎对上述任何目标都没有优势。考虑到在大多数妇科病例中肠道腔内进入的可能性极小，因此手术部位感染率较低，大多数科学协会已发布指南，反对在腹腔镜或阴道手术前使用任何肠道准备方案。尽管如此，外科医生仍未采用特定模式，继续开具此类医嘱。然而，根据最新证据，在微创和阴道妇科手术前应省略任何类型的术前肠道准备。
