Mechanical bowel preparation for gynecologic laparoscopy: a prospective randomized trial of oral sodium phosphate solution vs single sodium phosphate enema.

STUDY OBJECTIVE: To compare the effect of mechanical bowel preparation using oral sodium phosphate (NaP) solution vs single NaP enema on the quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures. DESIGN: Single-blind randomized controlled trial (Canadian Task Force classification I). SETTING: Academic teaching hospital. PATIENTS: Women undergoing gynecologic laparoscopic surgery. INTERVENTIONS: Administration of either oral NaP solution or single NaP enema for preoperative bowel preparation. MEASUREMENTS AND MAIN RESULTS: One hundred fifty-six women were enrolled, and 145 were randomized to receive either oral NaP solution (n = 72) or NaP enema (n = 73). Sixty-eight women in the oral solution group and 65 in the enema group completed the study. Assessment of the quality of the surgical field and bowel characteristics was performed using a surgeon questionnaire using Likert and visual analog scales. No significant differences were observed between the 2 groups in evaluation of the surgical field, bowel handling, degree of bowel preparation, or surgical difficulty. Surgical field quality was graded as excellent or good in 85% of women in the oral solution group and 91% of women in the enema group (p = .43). When surgeons were asked to guess the type of preparation used, they were correct only 52% of the time (κ = 0.04). Assessment of patient quality of life in the preoperative period was performed using a self-administered questionnaire using a visual analog scale. Severity of abdominal bloating and swelling, weakness, thirst, dizziness, nausea, fecal incontinence, and overall discomfort were significantly greater in the oral solution group. Women in the oral solution group also rated the preparation as significantly more difficult to administer, and were significantly less willing to try the same preparation in the future. CONCLUSION: Quality of the surgical field in patients undergoing advanced gynecologic laparoscopic procedures is similar after mechanical bowel preparation using either oral NaP solution and NaP enema. Adverse effects are more severe with oral NaP solution compared with NaP enema administration.

Pediatric and adolescent gynecologic laparoscopy.

Minimally invasive techniques to treat children and adolescents requiring surgery have increasingly become standard of care. Similarly, gynecologists frequently use laparoscopy to treat pelvic pathology. We present the necessary equipment and surgical techniques required to perform gynecologic procedures on the pediatric and adolescent population. We will give particular focus to the treatment of adnexal masses, chronic pelvic pain, endometriosis, and ovarian torsion. We will also discuss the role of the incidental appendectomy in children and adolescents.