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Randomized Controlled Trial
. 2020 Jul;31(7):1305-1313.
doi: 10.1007/s00192-019-04120-7. Epub 2019 Nov 26.

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

Jessica C Sassani  1 , Kelly Kantartzis  2 , Liwen Wu  3 , Anthony Fabio  4 , Halina M Zyczynski  5
Affiliations
Randomized Controlled Trial

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

Jessica C Sassani et al. Int Urogynecol J. 2020 Jul.

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: Bowel prep; Constipation; PAC-SYM; Pelvic organ prolapse; Sacrocolpopexy.

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Conflict of interest statement

Conflict of interest: The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow of participants ITT = Intention to treat which includes all participants allocated to each arm PPA = Per protocol analysis which includes participants who completed a bowel prep or did not complete a bowel prep, regardless of randomization arm
See this image and copyright information in PMC

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