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Comparison of two methods for mechanical bowel preparation in elective operations of colon
Karimian F, Moghadamyeghaneh Zh, Aminian A, Pasha Meysami A, Fazely Ms, Kazemeini A,
Volume 67, Issue 4 (7-2009)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Polyethylene glycol (PEG) solution can induce complications when used as preoperative bowel preparation. The aim of this study was to compare two methods for mechanical bowel preparation in elective operations of colon.
Methods: In a randomized clinical trial, 129 patients elected for anastomosis of colon and referred to the surgical clinic of Imam Khomeini Hospital of Tehran between March 2008 and March 2009 were included. They were randomly allocated into two groups of PEG1 (1liter of PEG or 70gr plus 15 mg bizacodil, n=63) and PEG4 (4 liter of PEG), according to the way of bowel preparation and on the day before surgery, they received oral and IV prophylactic antibiotics and cleared solutions. In the morning of the surgery, they received their medication during 240 minutes. Then, they underwent anastomosic surgery of colon. The principle variables recorded were nausea, vomiting, flatulence, Na and K in the night before surgery, patients' and surgeons' satisfaction from bowel preparation and postoperative infection and leakage.
Results: The majority of the patients were male (62%). Nausea (28.57% vs. 98.48%, p=0.001), flatulence (36.51% vs. 95.45%, p=0.001), and vomiting (4.76% vs. 75.76%, p=0.001) were significantly lower in PEG1 and the patients' satisfaction were significantly higher (59.02% vs. 1.52%, p=0.001) Peroperative Na was significantly higher in PEG4 group (141.21±3.63 vs. 139.94±2.97mg/l, p=0.001) and serum K was significantly lower (3.55±0.25 vs. 3.76±0.21, p=0.001). Surgeons' satisfaction were significantly higher in PEG4 group (good to very good 72.73% vs. 43.54%, p=0.001). Postoperative infection of surgical site, anastomosis leakage and ICU admission were comparable between study groups.
Conclusions: Bowel preparation with 1 liter of PEG plus 3 bizacodile pills instead of 1 liter of PEG in patients undergoing elective anastomosis of colon is not only associated with lesser nausea, vomiting, flatulence, but also increases the patients' satisfaction and tolerance, lessens electrolyte disturbances and do not influence postoperative infection of surgical site and anastomosis leakage.


Assessing the role of enema in improving outcomes and complications of benign gynecological laparoscopy: a randomized clinical trial
Zahra Asgari, Azam Barkhordarinasab, Reihaneh Hosseini , Alireza Hadizadeh, Venus Chegini, Sara Farzadi,
Volume 79, Issue 11 (2-2022)
Abstract
Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results.
Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software.
Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP.
Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.
 

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