The Effect of Preoperative Fiber on Postoperative Bowel Function After Pelvic Reconstructive Surgery: A Randomized Controlled Trial

Maheshwari, Deepali; Hall, Cynthia; Jia, Xibei; Tangada, Abhilasha; Wu, Emily K.; Leung, Katherine; Flynn, Michael K.

doi:10.1097/spv.0000000000001203

Cited by 2 publications

(8 citation statements)

References 17 publications

(39 reference statements)

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“…The most recent study was published in 2022 by Maheshwari et al 16 This unblinded randomized controlled trial of 71 patients compared a regimen of 7 days of preoperative fiber plus senna and docusate after surgery with patients receiving only senna and docusate postoperatively. Patients having prolapse surgery were approached for inclusion.…”

Section: Resultsmentioning

confidence: 99%

“…However, the remaining procedures were still varied. In the studies with negative results, 15,16 this heterogeneity may mask a true benefit for the treatment regimens if the proportion of patients having high constipation risk surgery was higher in the treatment groups. Future research efforts should focus on larger studies of patients having higher risk procedures, including sphincteroplasty and fistula repair, where decreasing constipation is likely to have the greatest impact.…”

Section: Discussionmentioning

confidence: 99%

“…For example, an isolated anterior vaginal repair has no dissection in the rectovaginal space, compared with a colpocleisis, which may affect postoperative constipation. Recognizing the differential effects of procedures on constipation, 3 of the 4 studies 13,15,16 specifically excluded the anticipated highest risk surgery intestinal or sphincter procedures. The fourth study 14 did not explicitly include or exclude intestinal/sphincter procedures, but the authors did exclude posterior colporrhaphy, presumably for a similar rationale.…”

Section: Discussionmentioning

confidence: 99%

“…There is moderate-quality evidence that use of a laxative is better than placebo 13 and that combination laxative regimens are more effective than single agent docusate 14,15 . The available evidence suggests that there is not a benefit to preoperative fiber when patients are receiving a postoperative laxative regimen 16 …”

Section: Discussionmentioning

confidence: 99%

“…14,15 The available evidence suggests that there is not a benefit to preoperative fiber when patients are receiving a postoperative laxative regimen. 16 The small size of the included studies introduces problems with heterogeneity of the surgical approaches. Whereas randomization may reduce bias, small sample size may result in persistent heterogeneity between cohorts, and findings of small studies should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Woodbury¹,

Coughlin²,

Dubois³

et al. 2023

UROGC

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Importance Constipation is common after pelvic surgery, and studies suggest that surgeons underestimate the negative impact of constipation on patients. Patients undergoing pelvic reconstructive surgery are a unique population requiring special consideration in the prevention and management of constipation. Objective This study aimed to systematically review the literature to identify evidence for prevention of postoperative constipation with medications or fiber in patients undergoing reconstructive pelvic surgery. Study Design A structured literature search was performed of five databases (MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library) from inception to June 2022 for studies of postoperative laxative or fiber use in adult patients undergoing benign pelvic reconstructive surgery. Studies of preoperative bowel preparation and nonsurgical patients were excluded. Data on postoperative constipation were extracted for a qualitative analysis of the literature. Grading of Recommendations Assessment, Development, and Evaluation methodology was applied to assess the quality of evidence. Results We identified 86 references after deduplication. Only 4 studies with a total of 344 patients were eligible for inclusion in the review. The included studies were all randomized controlled trials assessing time to first bowel movement with the earliest published in 2010. Laxative use decreased constipation more than placebo. Multiple-agent laxative use appeared to decrease bothersome constipation more than single-agent docusate. Preoperative fiber did not decrease constipation. By Grading of Recommendations Assessment, Development, and Evaluation criteria, all four studies provide moderate-quality evidence. Conclusions Few studies have investigated laxative regimens in patients after urogynecologic surgery. The available literature is moderate quality and suggests benefit of multiple-agent treatment over docusate only or no treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Woodbury¹,

Coughlin²,

Dubois³

et al. 2023

UROGC

View full text Add to dashboard Cite

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Does a Preoperative Bowel Regimen Change Time to Bowel Movement? A Randomized Clinical Trial

Holubyeva,

Goodwin,

O’Shaughnessy

et al. 2024

UROGC

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Importance This study is important because it aimed to assess an intervention to decrease patient discomfort after a robotic sacral colpopexy. Objective Our primary outcome was to determine whether preoperative use of polyethylene glycol decreases time to first bowel movement postoperatively. Secondary outcomes include degree of pain with first bowel movement and stool consistency. Study Design This was a randomized controlled trial. The experimental group was assigned polyethylene glycol daily for 7 days before surgery and the control group was not. All patients received polyethylene glycol postoperatively. Results There was no statistically significant reduction in the time to first postoperative bowel movement when preoperative polyethylene glycol was used (mean [SD] in days for the control and experimental groups of 2.32 [0.99] and 1.96 [1.00], P = 0.21). There was a statistically significant reduction in pain levels with the first postoperative bowel movement in the experimental group (median [IQR] of 4 [2–5] vs 1 [0–2], P = 0.0007). Postoperative day 1 pain levels were also significantly lower in the experimental group (median [IQR] of 4 [3–6] vs 2 [0–4], P = 0.0484). In addition, patients had decreased average postoperative pain levels over 7 days with an estimated difference in the median pain levels of 1.88 units (95% confidence interval, 0.64–3.12; P = 0.0038). Conclusions Preoperative administration of polyethylene glycol did not decrease time to first postoperative bowel movement. Patients in the experimental group exhibited less pain with their first postoperative bowel movement and had improved pain levels on postoperative day 1.

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The Effect of Preoperative Fiber on Postoperative Bowel Function After Pelvic Reconstructive Surgery: A Randomized Controlled Trial

Cited by 2 publications

References 17 publications

Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Does a Preoperative Bowel Regimen Change Time to Bowel Movement? A Randomized Clinical Trial

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