Optimizing Postoperative Gastrointestinal Dysmotility Following Total Laparoscopic Hysterectomy: a Randomized Control Trial.
This study is a prospective three-arm randomized controlled trial at a single academic-affiliated institution designed to assess the effect of common bowel care regimens on return of bowel function following total laparoscopic hysterectomy. Subjects were randomized using an equal allocation ratio to one of three groups: no bowel care medication, docusate sodium, or polyethylene glycol 3350 (PEG) for the first five days postoperatively. Women aged 18-85 years old undergoing total laparoscopic hysterectomy for benign indications were included. Exclusion criteria included a known underlying gynecologic malignancy, pre-existing gastrointestinal disorders such as Crohn’s disease, ulcerative colitis, irritable bowel syndrome, history of bowel resection, insulin-dependent diabetes or gastroparesis, known gastric dysmotility, chronic use of pain medications, anticipated bowel surgery, or non-English speaking. The primary outcome of the study was to assess the time to first bowel movement after randomization to a postoperative bowel care regimen. Secondary outcomes assessed were time to first flatus postoperatively, narcotic use measured in total oral morphine equivalents in the first five days postoperatively, as well as the constipation score and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire score. There were no significant differences in time to first bowel movement postoperatively amongst those receiving no bowel care regimen, docusate sodium, or PEG (2.64 ± 1.19, 2.80 ± 1.08, 3.06 ± 1.18 days; p=0.436). Similarly, there were no significant differences in time to first flatus: 1.06 days (interquartile range 0.89-1.70) in the control group, 1.05 days (interquartile range 0.78-1.37) in the docusate sodium group, and 1.11 days (interquartile range 0.82-1.40) in the PEG group (p=0.975). Total narcotic use in the first five days postoperatively, constipation score, and the PAC-SYM score did not vary significantly amongst the groups. Body mass index (BMI) was a significant predictor of time to first bowel movement with an increased BMI associated with a shorter time to first bowel movement [HR 1.05 (1.01, 1.10); p=0.013]. In those undergoing laparoscopic hysterectomy for benign indications without any preexisting gastrointestinal disorders, the prescription of a bowel care medication does not significantly affect return of bowel function.