Evaluating Mechanical Bowel Preparation Prior to Total Laparoscopic Hysterectomy

BACKGROUND AND OBJECTIVES Mechanical bowel preparation (MBP) has been used prior to total laparoscopic hysterectomy (TLH), but evidence for its use is lacking. Our study seeks to assess whether or not completion of preoperative MBP prior to TLH improves visualization of the surgical field, bowel handling, or overall ease of the operation. METHODS Women aged 18-65 years undergoing TLH for benign indications at a level 1 trauma center were randomized to a bowel preparation (BP; n = 39) or non-bowel preparation (NP; n = 39) regimen. After each operation, the surgeon completed a survey about intraoperative visualization of the surgical field, bowel handling, and the overall ease of the operation. The surgeon was also asked whether or not he thought the patient had completed MBP. The patient completed a survey about pre- and postoperative gastrointestinal discomfort. The surgeon was blinded to whether MBP was completed before the operation. RESULTS There was no difference in intraoperative visualization, bowel handling, or overall ease of the operation between the BP and NP groups. Comfort levels before and after surgery were not significantly different between the two groups. The surgeon was able to correctly predict whether the patient performed MBP in 59% of cases. CONCLUSION The routine use of MBP before TLH does not improve intraoperative visualization, bowel handling, or overall ease of performing the procedure. It also has no significant effect on patient comfort levels. MBP is not indicated before TLH for benign indications.