Effect of non-mechanical bowel preparation on postoperative gastrointestinal recovery following surgery on malignant gynecological tumors: A randomized controlled trial

Abstract

Objective: To investigate the efficacy and safety of non-mechanical bowel preparation (non-MBP) in patients undergoing surgery for malignant gynecological tumors.

Methods: Patients undergoing surgery for a gynecological malignancy (n = 105) were randomized to receive mechanical bowel preparation (MBP) or non-MBP. Parameters indicating postoperative gastrointestinal function recovery were the primary outcomes. The secondary outcomes included the number of postoperative complaints, the plasma levels of D-lactate and diamine oxidase (DAO), ease of visualization of the surgical field, involuntary defecation during surgery, operation time, wound healing, surgical site infection, length of hospital stay, and tolerance to MBP.

Results: The participants in the non-MBP group exhibited shorter time intervals until the first postoperative bowel movement (27.87 vs. 29.48 h), first passage of flatus (50.96 vs. 55.08 h), and first passage of stool (75.94 vs. 98.50 h) compared with the MBP group, while they also exhibited fewer postoperative gastrointestinal symptoms, including nausea (18.9% vs. 38.5%), vomiting (26.4% vs. 51.9%), abdominal pain (34.0% vs. 78.9%), and bloating (3.8% vs.26.9%). The plasma D-lactate and DAO levels were significantly increased following bowel preparation compared with the baseline levels in the MBP group (2.93 vs. 5.68 nmol/mL and 20.46 vs. 54.49 ng/mL, respectively), but no such differences were observed in the non-MBP group. Compared with the MBP group, surgical field visualization was superior (92.45% vs. 78.85%), and the operation time was shorter (173.58 vs. 203.88 min) in the non-MBP group. The patients undergoing MBP complained of bloating (¹82.35%), an unpleasant taste (78.43%), sleep disturbance (70.59%), nausea (68.63%), abdominal pain (64.71%), vomiting (45.10%), polydipsia (33.33%), dizziness (25.49%), and headache (7.84%).

Conclusions: The use of non-MBP in patients undergoing surgery for gynecological malignancies is more conducive to the postoperative recovery of gastrointestinal function.

Keywords: Enhanced recovery after surgery; Gynecological malignant tumors; Mechanical bowel preparation; Randomized controlled trial.