title: Mechanical bowel preparation for gynecologic laparoscopy: a prospective randomized trial of oral sodium phosphate solution vs single sodium phosphate enema.
abstract: OBJECTIVE
  To compare the effect of mechanical bowel preparation using oral sodium phosphate (NaP) solution vs single NaP enema on the quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures.
  
  
  METHODS
  Single-blind randomized controlled trial (Canadian Task Force classification I).
  
  
  METHODS
  Academic teaching hospital.
  
  
  METHODS
  Women undergoing gynecologic laparoscopic surgery.
  
  
  METHODS
  Administration of either oral NaP solution or single NaP enema for preoperative bowel preparation.
  
  
  RESULTS
  One hundred fifty-six women were enrolled, and 145 were randomized to receive either oral NaP solution (n = 72) or NaP enema (n = 73). Sixty-eight women in the oral solution group and 65 in the enema group completed the study. Assessment of the quality of the surgical field and bowel characteristics was performed using a surgeon questionnaire using Likert and visual analog scales. No significant differences were observed between the 2 groups in evaluation of the surgical field, bowel handling, degree of bowel preparation, or surgical difficulty. Surgical field quality was graded as excellent or good in 85% of women in the oral solution group and 91% of women in the enema group (p = .43). When surgeons were asked to guess the type of preparation used, they were correct only 52% of the time (κ = 0.04). Assessment of patient quality of life in the preoperative period was performed using a self-administered questionnaire using a visual analog scale. Severity of abdominal bloating and swelling, weakness, thirst, dizziness, nausea, fecal incontinence, and overall discomfort were significantly greater in the oral solution group. Women in the oral solution group also rated the preparation as significantly more difficult to administer, and were significantly less willing to try the same preparation in the future.
  
  
  CONCLUSIONS
  Quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures is similar after mechanical bowel preparation using either oral NaP solution and NaP enema. Adverse effects are more severe with oral NaP solution compared with NaP enema administration.
authors.affiliation: Program of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. lyang@bidmc.harvard.edu
authors.forename: Linda C
authors.initials: LC
authors.lastname: Yang
authors.forename: Deborah
authors.initials: D
authors.lastname: Arden
authors.forename: Ted T M
authors.initials: TT
authors.lastname: Lee
authors.forename: Suketu M
authors.initials: SM
authors.lastname: Mansuria
authors.forename: Amy N
authors.initials: AN
authors.lastname: Broach
authors.forename: Lori
authors.initials: L
authors.lastname: D'Ambrosio
authors.forename: Richard
authors.initials: R
authors.lastname: Guido
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000328:Adult; D002400:Cathartics / Q000008:administration & dosage* / Q000627:therapeutic use; D004733:Enema / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010710:Phosphates / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate