Bowel preparation prior to laparoscopy

Mechanical bowel preparation (MBP) with preoperative oral or rectal hyperosmotic laxatives prior to intra-abdominal surgery is neither new nor limited to gynaecological surgery. The hypotheses for its use in gynaecological surgery are:

• to improve bowel handling

• to improve visualization

• to decrease risk from faecal contamination if inadvertent bowel injury occurs.

At laparotomy, the bowels may be manually packed or retracted, however this is not feasible at laparoscopic surgery, and bowel ma­nipulation and positioning has been perceived as a major problem (1). Nevertheless, the risk of bowel injury leading to peritoneal contamination and sepsis in laparoscopic gynaecological surgery is minimal, since the risk of injury remains very low (2). There are seven randomized controlled trials (RCTs) from the gynaecological literature that compare MBP with no MBP and the results of these are summarized in Table 47.1. Together, these studies report no sig­nificant benefit of mechanical bowel preparation at laparoscopy for benign gynaecological conditions.

Further evidence from the colorectal literature has shown similar results for when the bowel is intentionally opened, both in terms of anastomotic leakage and the visualization and handling issues that have been covered in the gynaecological trials. Again, these data col­lectively suggest that the principles as to why MBP would be used in this setting do not hold true in rigorous, evidence-based assess­ments with no clinical improvements and significant impacts on pa­tient well-being, and they should not be recommended for routine use at gynaecological laparoscopy (3).