Preoperative mechanical bowel preparation for gynecologic surgeries: a systematic review with meta-analysis.
Bibliographic record
Abstract
Background: Mechanical bowel preparation before gynecologic surgeries has been administered for decades but its use is controversial today. Objectives: To assess the efficacy and tolerance of mechanical bowel preparation before benign laparoscopic or vaginal gynecologic surgeries. Search strategy: MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences published up to December 2021. Selection criteria: Randomized clinical trials in any language comparing mechanical bowel preparation before laparoscopic and vaginal gynecologic surgeries with no preparation were included. Data collection and analysis: Two reviewers independently screened and extracted data from selected articles and assessed the risk of bias. Surgeon findings, operative outcomes and patient’s pre-operative symptoms and satisfaction were collected. Main results: Twelve studies (1715 patients) of the 925 records screened were included. No significant differences were observed on surgical field view (RR=1.01, 95%CI 0.97-1.05, p=0.66, I 2 =0%); bowel handling (RR=1.01, 95%CI 0.95-1.08, p=0.78, I 2 =67%). There were no statistically significant differences in peri-operative findings. Mechanical bowel preparation was associated with increased pain (MD=11.62[2.80-20.44], I 2 =76, p=0.01); weakness (MD=10.73[0.60-20.87], I 2 =94, p=0.04); hunger (MD=17.52[8.04-27.00], I 2 =83, p=0.0003); insomnia (MD=10.13[0.57-19.68], I 2 =82, p=0.04); and lower satisfaction (RR=0.68 95%CI 0.53-0.87, I 2 =76%, p=0.002). Conclusion: In view of the adverse effects induced by mechanical bowel preparation and the lack of any surgical benefit, the routine its use prior to benign gynecological surgeries should be abandoned. Funding: This work was granted by the French network of University Hospitals HUGO and Fonds de recherche du Québec-Santé.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.025 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".