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Bowel preparation prior to minimally invasive sacrocolpopexy: a randomized controlled trial

  • Jessica C. SassaniEmail author
  • Kelly Kantartzis
  • Liwen Wu
  • Anthony Fabio
  • Halina M. Zyczynski
Original Article
  • 18 Downloads

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Sacrocolpopexy Pelvic organ prolapse Bowel prep Constipation PAC-SYM 

Notes

Acknowledgements

Our research was supported by the National Institutes of Health through Grant Number UL1TR001857.

Compliance with ethical standards

Conflicts of interest

The authors report that they have no conflicts of interest.

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of Medicine, Magee-Womens HospitalPittsburghUSA
  2. 2.Banner University Medical CenterUniversity of ArizonaPhoenixUSA
  3. 3.Department of BiostatisticsUniversity of PittsburghPittsburghUSA
  4. 4.Epidemiology Data Center, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA

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