Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy.
BACKGROUND
Postoperative traditional feeding protocols are not based on scientific studies, but rather on anecdotal evidence. We present the first prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy in an attempt to determine its effect on the length of hospital stay.


METHODS
Twenty consecutive patients undergoing radical hysterectomy were entered onto a prospective trial of aggressive postoperative bowel stimulation, which consisted of 30 cc milk of magnesia p.o. b.i.d. starting on postoperative day 1 and biscolic suppositories q.d. starting on day 2. A clear liquid diet was begun following flatus or bowel movement and patients were discharged 12 h after tolerating a clear liquid diet. Diet was slowly advanced at home.


RESULTS
Median time to flatus was 3 days, bowel movement 3 days, and clear liquid diet 3 days. Median time to discharge was 4 days. No patients developed ileus or bowel obstructions and there were no readmissions for bowel complications. Our median time to discharge of 4 days represents a 50% reduction in hospital stay compared to our previous prospective study using traditional postoperative bowel management (8 days), which was statistically significant at P = 0.001.


CONCLUSIONS
Aggressive bowel stimulation with milk of magnesia and biscolic suppositories resulted in early return of bowel function and early discharge with no noticeable complications.
Fanning
J
J
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Toledo, Ohio 43614, USA.
Yu-Brekke
S
S
D000328:Adult; D000368:Aged; D002400:Cathartics / Q000494:pharmacology*; D004032:Diet; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007422:Intestines / Q000187:drug effects* / Q000502:physiology*; D008277:Magnesium Oxide / Q000494:pharmacology*; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D013488:Suppositories
D002400:Cathartics; D013488:Suppositories; D008277:Magnesium Oxide