Introduction and hypothesis
The objective was to determine if a bowel preparation prior to minimally invasive sacrocolpopexy (MIS) influences post-operative constipation symptoms. We hypothesized that women who underwent a bowel preparation would have an improvement in post-operative defecatory function.
In this randomized controlled trial, women undergoing MIS received a pre-operative bowel preparation or no bowel preparation. Our primary outcome was post-operative constipation measured by the Patient Assessment of Constipation Symptoms (PAC-SYM) 2 weeks post-operatively. Secondary outcomes included surgeon’s perception of case difficulty. Both intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. Analyses were carried out using t test, Fisher’s exact test, the Wilcoxon test and the Chi-squared test.
Of 105 enrolled women, 95 completed follow-up (43 preparation and 52 no preparation). Baseline characteristics and rates of complications were similar. No differences were noted on ITT. The post-operative abdominal PAC-SYM subscale was closer to baseline for women who received a bowel preparation on PPA (change in score 0.74 vs 1.08, p = 0.045). Women who underwent a preparation were less likely to report strain (6.0% vs 26.7%, p = 0.009) or type 1 Bristol stool on their first post-operative bowel movement (4.3% vs 17.5%, p = 0.047). Surgeons were more likely to rate the complexity of the case as “more difficult than average” (54.4% vs 40.1%, p = 0.027) in those without a bowel preparation.
Although there was no difference in ITT analysis, women who underwent a bowel preparation prior to MIS demonstrated benefit to post-operative defecatory function with a corresponding improvement in surgeon’s perception of case complexity.
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Wells T, Plante M, McAlpine JN. Preoperative bowel preparation in gynecologic oncology: a review of practice patterns and an impetus to change. Int J Gynecol Cancer. 2011;21(6):1135–42.
Slim K, Vicaut E, Launay-Savary MV, 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(2):203–9.
Muzii L, Bellati F, Zullo MA, Manci N, Angioli R, Panici PB. Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial. Fertil Steril. 2006;85(3):689–93.
Siedhoff M, Clark LH, Hobbs KA, Findley AD, Moulder JK, Garrett JM. Mechanical bowel preparation before laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2014;123(3):562–7.
Ballard A, Parker-Autry CY, Markland AD, Varner RE, Huisingh C, Richter HE. Bowel preparation before vaginal prolapse surgery: a randomized controlled trial. Obstet Gynecol. 2014;123:232–8.
Jelovsek J, Barber MD, Paraiso MF, Walters MD. Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence. Am J Obstet Gynecol. 2005;193(6):2105–11.
Raza-Khan F, Cunkelman J, Lowenstein L, Shott S, Kenton K. Prevalence of bowel symtpoms in women with pelvic floor disorders. Int Urogynecol J. 2010;21(8):933–8.
Whitehead W, Bradley CS, Brown MB, Brubaker L, Gutman RE, Varner E, et al. Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007;197(1):78.e1–7.
Weir L, Nygaard IE, Wilken J, Brandt D, Janz KF. Postoperative activity restrictions: any evidence? Obstet Gynecol. 2006;107(2):305–9.
Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol stool form scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(7):693–703.
Frank L, Kleinman L, Farup C, Taylor L, Miner P. Pyschometric validation of a constipation symptom assessment questionnaire. Scan J Gastroenterol. 1999;34(9):870–7.
Patel M, O'Sullivan D, LaSala C. Constipation symptoms before and after vaginal and abdominal pelvic reconstructive surgery. Int Urogynecol J. 2011;22:1413–9.
Yang L, Arden D, Lee TT, Mansuria SM, Broach AN, D'Ambrosio L, 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(2):149–56.
Yiannakou Y, Tack J, Dubois B, Quigley EMM, Ke MY, DaSilva S, Joseph A, Kerstens R. The PAC-SYM questionnaire for chronic constipation: defining the minimal important difference. Aliment Pharmacol Ther 2017;46(11–12):1103–11.
Linder B, Occhino JA, Habermann EB, Glasgow AE, Bews KA, Gershman B. A national contemporary analysis of perioperative outcomes for open versus minimally-invasive sacrocolpopexy. J Urol. 2018;200(4):862–7.
Our research was supported by the National Institutes of Health through Grant Number UL1TR001857.
Conflicts of interest
The authors report that they have no conflicts of interest.
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Clinical trial registration
1. Date of registration: 6 March 2013
2. Date of initial participant enrollment: 18 March 2013
3. Clinical trial identification number: NCT01805310
4. URL of registration site: https://clinicaltrials.gov/ct2/show/NCT01805310?cond=sacral+colpopexy&cntry=US&state=US%3APA&city=pittsburgh&rank=1
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Sassani, J.C., Kantartzis, K., Wu, L. et al. Bowel preparation prior to minimally invasive sacrocolpopexy: a randomized controlled trial. Int Urogynecol J 31, 1305–1313 (2020). https://doi.org/10.1007/s00192-019-04120-7
- Pelvic organ prolapse
- Bowel prep