Dr. Kalogera on Bowel Preparation Following Minimally Invasive or Open Hysterectomies

Eleftheria Kalogera, MD, MSc, instructor in Obstetrics and Gynecology, fellow in Gynecologic Oncology, in the department of Obstetrics and Gynecology, at Mayo Clinic College of Medicine, discusses the controversial topic of bowel preparation following minimally invasive or open hysterectomies.

Enhanced recovery protocols for after surgery are in place to help ensure that each patient has the best possible outcome from their procedure. The enhanced recovery pathway, says Kalogera, incorporates evidence-based practices to improve patient care. Within this framework, bowel preparation—the process of removing feces from the colon prior to a surgical procedure—was a practice that many surgeons felt comfortable incorporating into practice without having data to support its effectiveness, she says.

The issue with this process is that many patients who receive it come in on the day of surgery in a dehydrated, catabolic state, says Kalogera, which could potentially increase their risk for post-surgical complications. For this reason, many surgeons have found innovative ways to completely omit the procedure from their practices. There are data that show that outcomes were still preserved, safety remained consistent, and there was no increase in post-surgical infection rates, and yet, the majority of surgeons still use the procedure.

That’s why bowel preparation continues to be such a controversial subject in the field, says Kalogera. Although the enhanced recovery pathway advocates for evidence-based research, and data suggests that it’s safe to omit this procedure, many surgeons are still reluctant to do so.

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