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Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature

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Abstract

Purpose

The purpose of this review is to assess the impact of mechanical and oral antibiotics bowel preparation on surgical performance and to investigate their role before gynecologic surgical procedures regarding the infection rates. We also aim to study the updated evidence regarding the use of these different types of bowel preparation, as well as the current preoperative practice applied.

Methods

An extensive search of the literature was conducted with Medline/PubMed, and the Cochrane Library Database of Systematic Reviews being used for our primary search.

Results

To date, due to the conflicting guidelines by the scientific societies, surgeons do not use a specific pattern of bowel preparation regimen. There are no strong evidence supporting mechanical bowel preparation, but instead, in many cases, patients’ adverse effects, both physiological and psychological have been noted. On the other hand, the combined use of oral antibiotic and mechanical bowel preparation has been proven beneficial in colorectal surgery in reducing postoperative morbidities.

Conclusion

Based on current literature, in gynecologic surgeries with minimal probability of intraluminal entry, a regimen without any bowel preparation should be applied. The combined administration of both mechanical and oral antibiotic bowel preparation, or even the use of the oral antibiotics alone, should be preserved for cases of increased complexity, where bowel involvement is highly anticipated, such as in gynecologic oncology, as stated in the ERAS protocols. Nonetheless, further research specific to gynecologic surgery is required.

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Authors and Affiliations

  1. Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece

    Michail Diakosavvas, Nikolaos Thomakos, Dimitrios Haidopoulos & Alexandros Rodolakis

  2. Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528, Athens, Greece

    Michael Liontos

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  1. Michail Diakosavvas
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  2. Nikolaos Thomakos
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  3. Dimitrios Haidopoulos
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MD: data collection and analysis, and manuscript writing. NT: project development and manuscript writing. DH: critical revision of the article and manuscript editing. ML: critical revision of the article and manuscript editing. AR: overall responsibility and final approval of the article.

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Correspondence to Michail Diakosavvas.

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Diakosavvas, M., Thomakos, N., Haidopoulos, D. et al. Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature. Arch Gynecol Obstet 302, 1049–1061 (2020). https://doi.org/10.1007/s00404-020-05704-1

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