Mechanical Bowel Preparation Can Be Omitted in the Modern Era of Minimally Invasive Gynaecological Surgery and ERAS Pathways

Dear Editor, With great deal of interest, we read the article entitled “The effect of mechanical bowel preparation on the surgical field in laparoscopic gynecologic surgeries: A prospective randomized controlled trial” by Ozturk et al. [1] The study evaluates the effects of mechanical bowel preparation (MBP) prior to laparoscopic gynecologic operation and whether it can offer advantages intraoperatively. As already discussed, MBP is discouraged in such operations by ERAS guidelines [2]. It should be highlighted that MBP was applied for two days prior to surgery. A fact that could raise the cost and patient’s dissatisfaction. Moreover, the evaluation of the intraoperative visualization of the surgical field, intestinal load and overall case of surgery were based on the subjective opinion of an experienced laparoscopic surgeon, and this is similar to other studies, using for example the Likert scale [3]. A recent literature review showed that MBP of any type seems to offer no advantage to any of the above mentioned intraoperative parametres [4]. Another metanalysis proposed that MBP should be abandoned prior to benign laparoscopic gynecological operations [5]. Furthermore, in the subgroup analysis of your study, no significant differences were identified in either patients with malignant diseases or those with high body mass index. Such a finding is crucial and highlights that there is no role of MBP in gynecologic laparoscopy independent of the difficulty of the planned surgery. Although, the findings of your study as well as other studies on the field are not supportive for MBP use, we should also mention that there is a gap between guidelines and reality/current medical practise as the approach is based on surgeon’s preference worldwide [6]. Nevertheless, the role of MBP could be debated by some surgeons in their contemporary practise, based on the existing data, we recommend that MBP could be abandoned in the modern era of minimally invasive gynecologic surgery and enhanced recovery pathways. Once again, we would like to thank the authors for their excellent contribution. Data availability statement