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Preoperative Bowel Preparation in Gynecologic Oncology: A Review of Practice Patterns and an Impetus to Change
  1. Tiffany Wells, MD*,
  2. Marie Plante, MD,
  3. Jessica N. McAlpine, MD,
  4. the Communities of Practice Groups on behalf of the Society of Gynecologic Oncologists of Canada
  1. *Department of Gynecology and Obstetrics, University of Alberta, Edmonton, Alberta;
  2. Department of Gynecology and Obstetrics, Université Laval, Quebec City, Quebec; and
  3. Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada.
  1. Address correspondence and reprint requests to Jessica N. McAlpine, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, 2775 Laurel St, 6th Floor, Vancouver, British Columbia, Canada V5Z1M9. E-mail: jessica.mcalpine{at}vch.ca.

Abstract

Objectives: Preoperative mechanical bowel preparation (MBP) is commonly used in gynecologic oncology (GO). We wished to assess the practice patterns and beliefs within the Society of Gynecologic Oncologists of Canada (GOC), review the literature on MBP as applicable to GO surgeries, and construct recommendations specific to our subspecialty.

Methods: A 23-question, 10-minute Internet survey was sent to 110 GOC members regarding their use, rationale, and understanding of the literature pertaining to MBP for GO surgeries. The historical justifications for using MBP before pelvic and abdominal surgery were identified through literature review.

Results: Half of respondents (48%) routinely order MBP despite acknowledgment in 77% that there was no good evidence to support its use. Use encompassed all cancer sites (53% ovary, 32% endometrial, 27% cervical, and 8% vulvar) and approaches (43% laparotomy and 29% laparoscopy/robotics). The most common reasons cited for ordering MBP were to decrease risk of anastomotic leak and improve visualization. In the last 5 years, use of MBP has decreased in most (77%) GOC respondents. Of all respondents, 71% felt that formal recommendations specific to the field of GO would be helpful. None of the arguments for using MBP could be justified in the literature. In contrast, common and often serious sequelae from MBP are frequently described. Admitted use of bowel preparation in other surgical specialties was even higher (53%-99%) than within the GOC.

Conclusions: There is no literature to support the routine use of MBP in GO. Published recommendations (herein) should support and guide change in practice.

  • Preoperative mechanical bowel preparation
  • Survey
  • Practice patterns
  • Surgery
  • Literature review

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Footnotes

  • Supported by the Gynecologic Oncologists of Canada.

  • The authors have no conflict of interest to declare.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.ijgc.com).