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The use of mechanical bowel preparation in laparoscopic gynecologic surgery: a decision analysis

      Objective

      The use of mechanical bowel preparation prior to laparoscopy is common in gynecology, but its use may affect the rates of perioperative events and complications. Our objective was to compare different mechanical bowel preparations using decision analysis techniques to determine the optimal preparation prior to laparoscopic gynecological surgery.

      Study Design

      A decision analysis was constructed modeling perioperative outcomes with the following mechanical bowel preparations: magnesium citrate, sodium phosphate, polyethylene glycol, enema, and no bowel preparation. Comparisons were made using published utility values. Secondary analyses included the percentages that had 1 or more preoperative events and 1 or more intra- or postoperative complications.

      Results

      Overall, the highest utility values were for no bowel preparation (0.98) and magnesium citrate (0.97), whereas the other values were as follows: enema (0.95), sodium phosphate (0.94), and polyethylene glycol (0.91). The difference between no bowel preparation and magnesium citrate was less than the published minimally important differences for utilities, so there is likely no real difference between these strategies. The probability of having at least 1 preoperative event was lowest for no bowel preparation (1%), whereas the probability of having at least 1 intra- or postoperative complication was lowest with magnesium citrate (8%).

      Conclusion

      The highest utilities were seen with no bowel preparation, but the absolute difference between no bowel preparation and magnesium citrate was less than the minimally important difference. With similar overall utilities, our model raises questions as to whether mechanical bowel preparation is a necessary step prior to laparoscopic gynecological surgery. However, if a surgeon prefers a bowel preparation, magnesium citrate is the preferred option.

      Key words

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      References

        • Muzzi L.
        • Bellati F.
        • Zullo M.A.
        • Manci N.
        • Aangioli R.
        • Panici P.B.
        Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial.
        Fertil Steril. 2006; 85: 689-693
        • Slim K.
        • Vicaut E.
        • Launay-Savary M.V.
        • Contant C.
        • Chipponi J.
        Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery.
        Ann Surg. 2009; 249: 203-209
        • Yang L.C.
        • Aarden D.
        • Lee T.T.
        • et al.
        Mechanical bowel preparation for gynecologic laparoscopy: a prospective randomized trial of oral sodium phosphate solution vs single sodium phosphate enema.
        J Minim Invasive Gynecol. 2011; 18: 149-156
        • Wells T.
        • Plante M.
        • McAlpine J.N.
        Preoperative bowel preparation in gynecologic oncology: a review of practice patterns and an impetus to change.
        Int J Gynecol Cancer. 2011; 21: 1135-1142
        • Oliveira L.
        • Wexner S.D.
        • Daneil N.
        • et al.
        Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions.
        Dis Colon Rectum. 1997; 40: 585-591
        • Ballard A.C.
        • Parker-Autry C.Y.
        • Markland A.D.
        • Varner R.E.
        • Huisingh C.
        • Richter H.E.
        Bowel preparation before vaginal prolapse surgery: a randomized controlled trial.
        Obstet Gynecol. 2014; 123: 232-238
        • Siedhoff M.T.
        • Clark L.H.
        • Hobbs K.A.
        • Findley A.D.
        • Moulder J.K.
        • Garrett J.M.
        Mechanical bowel preparation before laparoscopic hysterectomy: a randomized controlled trial.
        Obstet Gynecol. 2014; 123: 562-567
        • Vradelis S.
        • Kalaitakis E.
        • Sharifi Y.
        • et al.
        Addition of senna improves quality of colonoscopy preparation with magnesium citrate.
        World J Gastroenterol. 2009; 15: 1759-1763
        • Berkelhammer C.
        • Ekambaram A.
        • Silva R.G.
        Low-volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate.
        Gastrointest Endosc. 2002; 56: 89-94
        • Choi Y.S.
        • Suh J.P.
        • Kim J.K.
        • et al.
        Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation.
        World J Gastroenterol. 2011; 17: 242-248
        • Kao D.
        • Lalor E.
        • Sandha G.
        • et al.
        A randomized controlled trial of four precolonoscopy bowel cleansing regimens.
        Can J Gastroenterol. 2011; 25: 657-662
        • Jansen S.V.
        • Goedhard J.G.
        • Winkens B.
        • van Deursen C.T.
        Preparation before colonoscopy: a randomized controlled trial comparing different regimes.
        Eur J Gastroenterol Hepatol. 2011; 23: 897-902
        • van Vugt van Pinxteren M.W.
        • van Kouwen M.C.
        • van Oijen M.G.
        • van Achterberg T.
        • Nagengast F.M.
        A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial.
        Fam Cancer. 2012; 11: 337-341
        • McKenna T.
        • Macgill A.
        • Porat G.
        • Friedenberg F.K.
        Colonoscopy preparation: polyethylene glycol with Gatorade is as safe and efficacious as four liters of polyethylene glycol with balanced electrolytes.
        Digest Dis Sci. 2012; 57: 3098-3105
        • Hjelkrem M.
        • Stengel J.
        • Liu M.
        • Jones D.P.
        • Harrison S.A.
        MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies.
        Clin Gastroenterol Hepatol. 2011; 9: 326-332.e1
        • Forster J.A.
        • Thomas W.M.
        Patient preferences and side effects experienced with oral bowel preparations versus self-administered phosphate enema.
        Ann R Coll Surg Engl. 2003; 85: 185-186
        • Gold M.R.
        • Franks P.
        • McCoy K.I.
        • Fryback D.G.
        Toward consistency in cost-utility analyses: using national measures to create condition-specific values.
        Med Care. 1998; 36: 778-792
      1. Tufts University Cost-Effectiveness Analysis Registry. Tufts Medical Center Institute for Clinical Research and Health Policy Studies. Available at: https://research.tufts-nemc.org/cear4/. Accessed Dec. 1, 2011.

        • Zmora O.
        • Mahajna A.
        • Bar-Zakai B.
        • et al.
        Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial.
        Ann Surg. 2003; 237: 363-367
        • Teng T.O.
        • Wallace A.
        One thousand health-related quality-of-life estimates.
        Med Care. 2000; 38: 583-637
        • Won H.
        • Maley P.
        • Salim S.
        • Rao A.
        • Campbell N.T.
        • Abbott J.A.
        Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery: a randomized controlled trial.
        Obstet Gynecol. 2013; 121: 538-546
        • Miettinen R.P.
        • Laitinen S.T.
        • Makela J.T.
        • Paakkonen M.E.
        Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study.
        Dis Colon Rectum. 2000; 43 (discussion 75-7): 669-675
        • Fa-Si-Oen P.
        • Roumen R.
        • Buitenweg J.
        • et al.
        Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery.
        Dis Colon Rectum. 2005; 48: 1509-1516
        • Large M.C.
        • Kiriluk K.J.
        • Decastro G.J.
        • et al.
        The impact of mechanical bowel preparation on postoperative complications for patients undergoing cystectomy and urinary diversion.
        J Urol. 2012; 188: 1801-1805
        • Pena-Soria M.J.
        • Mayol J.M.
        • Anula R.
        • Arbeo-Escolar A.
        • Fernandez-Represa J.A.
        Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis.
        J Gastrointest Surg. 2008; 12 (discussion 2108-9): 2103-2108
        • Sugihara T.
        • Yasunaga H.
        • Horiguchi H.
        • et al.
        Does mechanical bowel preparation improve quality of laparoscopic nephrectomy? Propensity score-matched analysis in Japanese series.
        Urology. 2013; 81: 74-79
        • Ram E.
        • Sherman Y.
        • Weil R.
        • Vishne T.
        • Kravarusic D.
        • Dreznik Z.
        Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study.
        Arch Surg. 2005; 140: 285-288
        • Chaleokittii B.
        Comparative study between polyethylene glycol and sodium phosphate solution in elective colorectal surgery.
        J Med Assoc Thai. 2002; 85: 92-96
        • Itani K.M.
        • Wilson S.E.
        • Awad S.S.
        • Jensen E.H.
        • Finn T.S.
        • Abramson M.A.
        Polyethylene glycol versus sodium phosphate mechanical bowel preparation in elective colorectal surgery.
        Am J Surg. 2007; 193: 190-194
        • Shepherd J.P.
        • Lowder J.L.
        • Jones K.A.
        • Smith K.J.
        Retropubic and transobturator midurethral slings: a decision analysis to compare outcomes including efficacy and complications.
        Int Urogynecol J. 2010; 21: 787-793
        • Walters S.J.
        • Brazier J.E.
        Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D.
        Qual Life Res. 2005; 14: 1523-1532
        • Deng S.
        • Dong Q.
        • Wang J.
        • Zhang P.
        The role of mechanical bowel preparation before ileal urinary diversion: a systematic review and meta-analysis.
        Urol Int. 2014; 92: 339-348
        • Yamada T.
        • Kan H.
        • Matsumoto S.
        • et al.
        Dysmotility by mechanical bowel preparation using polyethylene glycol.
        J Surg Res. 2014; 191: 84-90
        • Davis D.
        • Evans M.
        • Jadad A.
        • et al.
        The case for knowledge translation: shortening the journey from evidence to effect.
        BMJ. 2003; 327: 33-35
        • Eskicioglu C.
        • Gagliardii A.
        • Fenech D.S.
        • Victor C.J.
        • McLeod R.S.
        Can a tailored knowledge translation strategy improve short term outcomes? A pilot study to increase compliance with bowel preparation recommendations in general surgery.
        Surgery. 2011; 150: 68-74