title: Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review.
abstract: OBJECTIVE
  Mechanical bowel preparation (MBP) continues to be widely used in gynecologic surgery, with the aim of reducing postoperative complications and improving the viewing and handling conditions in the surgical field. It is reported that MBP is an unpleasant patient experience and may be associated with adverse effects such as dehydration and electrolyte imbalance. This review evaluates the use of preoperative MBP compared with no MBP in adult patients undergoing open abdominal, laparoscopic, or vaginal surgery. Although the focus is on the use of MBP for gynecologic procedures, data from other surgical areas are covered when relevant.
  
  
  METHODS
  A comprehensive search of the databases Medline (from 1946), EMBASE (from 1947), PubMed, Cochrane Library Central (Register of Controlled Trials), and Google Scholar was performed to identify any randomized controlled trials (RCTs) and prospective or retrospective cohort studies comparing preoperative MBP to no MBP.
  
  
  RESULTS
  Forty-three studies were identified in various surgical specialties, of which there were 5 RCTs in gynecology. The gynecologic studies reported no benefit for MBP in operative time or improved surgical field of view but did report a more unpleasant patient experience when MBP is used. RCTs from colorectal and urologic surgery were powered for infectious morbidity and anastomotic leak and did not demonstrate improved patient outcomes when MBP was used.
  
  
  CONCLUSIONS
  Evidence from high-quality trials reports no or few benefits from MBP or rectal enema across surgical specialties. In the field of gynecologic surgery, high-quality evidence supports the view that MBP may be safely abandoned.
authors.affiliation: Royal Hospital for Women, University of New South Wales, Randwick, New South Wales, Australia. Electronic address: Amy.arnold@sesiahs.health.nsw.gov.au.
authors.forename: Amy
authors.initials: A
authors.lastname: Arnold
authors.affiliation: University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Lucy P
authors.initials: LP
authors.lastname: Aitchison
authors.affiliation: Department of Gynaecological Surgery, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Abbott
mesh_terms: D000328:Adult; D057868:Anastomotic Leak; D002400:Cathartics / Q000008:administration & dosage*; D013505:Digestive System Surgical Procedures; D017558:Elective Surgical Procedures; D005260:Female; D005766:Gastrointestinal Contents; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D014621:Vagina / Q000601:surgery*
chemical_list: D002400:Cathartics
keywords: Bowel preparation; Gynaecology; Laparoscopy; Surgery