Preoperative mechanical bowel preparation for gynecologic surgeries: a systematic review with meta-analysis.

Background: Mechanical bowel preparation before gynecologic surgeries has been administered for decades but its use is controversial today. Objectives: To assess the efficacy and tolerance of mechanical bowel preparation before benign laparoscopic or vaginal gynecologic surgeries. Search strategy: MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences published up to December 2021. Selection criteria: Randomized clinical trials in any language comparing mechanical bowel preparation before laparoscopic and vaginal gynecologic surgeries with no preparation were included. Data collection and analysis: Two reviewers independently screened and extracted data from selected articles and assessed the risk of bias. Surgeon findings, operative outcomes and patient’s pre-operative symptoms and satisfaction were collected. Main results: Twelve studies (1715 patients) of the 925 records screened were included. No significant differences were observed on surgical field view (RR=1.01, 95%CI 0.97-1.05, p=0.66, I 2 =0%); bowel handling (RR=1.01, 95%CI 0.95-1.08, p=0.78, I 2 =67%). There were no statistically significant differences in peri-operative findings. Mechanical bowel preparation was associated with increased pain (MD=11.62[2.80-20.44], I 2 =76, p=0.01); weakness (MD=10.73[0.60-20.87], I 2 =94, p=0.04); hunger (MD=17.52[8.04-27.00], I 2 =83, p=0.0003); insomnia (MD=10.13[0.57-19.68], I 2 =82, p=0.04); and lower satisfaction (RR=0.68 95%CI 0.53-0.87, I 2 =76%, p=0.002). Conclusion: In view of the adverse effects induced by mechanical bowel preparation and the lack of any surgical benefit, the routine its use prior to benign gynecological surgeries should be abandoned. Funding: This work was granted by the French network of University Hospitals HUGO and Fonds de recherche du Québec-Santé.