Bowel preparation prior to minimally invasive sacrocolpopexy: a randomized controlled trial
Open accessAbstract
Introduction and hypothesis The objective was to determine if a bowel preparation prior to minimally invasive sacrocolpopexy (MIS) influences post-operative constipation symptoms. We hypothesized that women who underwent a bowel preparation would have an improvement in post-operative defecatory function.Methods In this randomized controlled trial, women undergoing MIS received a pre-operative bowel preparation or no bowel preparation. Our primary outcome was post-operative constipation measured by the Patient Assessment of Constipation Symptoms (PAC-SYM) 2 weeks post-operatively. Secondary outcomes included surgeon's perception of case difficulty. Both intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. Analyses were carried out using t test, Fisher's exact test, the Wilcoxon test and the Chi-squared test.Results Of 105 enrolled women, 95 completed follow-up (43 preparation and 52 no preparation). Baseline characteristics and rates of complications were similar. No differences were noted on ITT. The post-operative abdominal PAC-SYM subscale was closer to baseline for women who received a bowel preparation on PPA (change in score 0.74 vs 1.08, p = 0.045). Women who underwent a preparation were less likely to report strain (6.0% vs 26.7%, p = 0.009) or type 1 Bristol stool on their first post-operative bowel movement (4.3% vs 17.5%, p = 0.047). Surgeons were more likely to rate the complexity of the case as "more difficult than average" (54.4% vs 40.1%, p = 0.027) in those without a bowel preparation.Conclusions Although there was no difference in ITT analysis, women who underwent a bowel preparation prior to MIS demonstrated benefit to post-operative defecatory function with a corresponding improvement in surgeon's perception of case complexity.
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In women undergoing POP surgery, bowel preparation versus no bowel preparation may result in no clinically relevant difference in readmission to hospital within 30 days (OR 0.16, 95% CI 0.01 to 3.24; 1 study, 95 women).
“Based on evidence from a single trial (Sassani 2020), there may be no clinically relevant difference in readmission to hospital rates between the two groups (OR 0.16, 95% CI 0.01 to 3.24; 1 study, 95 women; Analysis 5.2).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Results report 95 women with outcome data and say readmissions were similar between the bowel-preparation and no-preparation groups (p>0.05). Our copy does not report a 30-day readmission window or the cited odds ratio and confidence interval, so those specifics are not supported by this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Sassani 2020, the randomisation method was computer randomisation.
“Randomisation method: computer randomisation”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Materials and Methods section says participants were assigned by simple randomization in a 1:1 ratio, with research staff randomizing them when surgery was scheduled. It does not say that the randomization was computer-generated; the use of a computer remains unverified. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn Sassani 2020, the risk of attrition bias from incomplete outcome data was high.
“Incomplete outcome data (attrition bias) All outcomes High risk 51/52 Group A; however, 45/54 (17%) in Group B”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Results (page unavailable) report incomplete outcome data: 95 of 105 participants provided it. They give 43 participants in the prep group and 52 in the no-prep group, not the cited 51/52 and 45/54 figures. The paper does not itself rate attrition bias as high risk. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Sassani 2020, the risk of performance bias from blinding of participants and personnel was high.
“Blinding of participants and personnel (performance bias) All outcomes High risk Unable to be blinded”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Discussion (page unavailable) says a placebo would have masked patients to their assignment, supporting concern about participant blinding. But Materials and Methods (page unavailable) explicitly says physicians and fellows were blinded to group assignment. The paper therefore does not support the claim that both participants and personnel were unable to be blinded; it does not itself assign a high-risk performance-bias rating. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn Sassani 2020, the risk of detection bias from blinding of outcome assessment was low.
“Blinding of outcome assessment (detection bias) All outcomes Low risk Blinded”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
Materials and Methods (page unavailable) says physicians and fellows were blinded to group assignment, supporting blinding for the surgeon-assessed outcomes. But the primary constipation outcome was patient-reported, and the Discussion says a placebo would have masked patients to their assignment. The paper therefore does not support the citing sentence’s blanket assessment of low detection-bias risk for all outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In Sassani 2020, surgeons were blinded.
“Blinding: surgeons blinded”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
In Sassani 2020, the risk of selection bias from allocation concealment was unclear.
“Allocation concealment (selection bias) Unclear risk Not clear; conducted by researchers”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
In Sassani 2020, a power calculation was performed.
“Power calculation: to detect a minimally important difference in Patient Assessment of Constipation Symptoms (PAC‐SYM) of 0.45 from a mean of 0.96 82 trialists resulted in 80% power with 5% alpha error and 10% drop out and 20% cancellation”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
In Sassani 2020, the risk of selection bias from random sequence generation was unclear.
“Random sequence generation (selection bias) Unclear risk Not stated”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
There may be no clinically relevant difference in estimated blood loss between women given bowel preparation versus no bowel preparation.
“Based on evidence from a single trial (Sassani 2020), there may be no clinically relevant difference in estimated blood loss between the two groups (MD ‐6.50, 95% CI ‐28.98 to 15.98; 1 study, 95 women; low‐certainty evidence; Analysis 5.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Results report 95 women with outcome data and similar surgical complication rates, but do not report estimated blood loss by group. Searches for estimated and intraoperative blood loss, including the cited mean difference and confidence interval, found no passage in our copy that verifies the blood-loss claim. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThere may be no clinically relevant difference in length of hospital stay between women given bowel preparation versus no bowel preparation.
“Based on evidence from a single trial (Sassani 2020), there may be no clinically relevant difference in length of hospital stay between the two groups (MD 0.10, 95% CI ‐0.22 to 0.42; 1 study, 95 women; low‐certainty evidence; Analysis 5.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Results report 95 women with outcome data and an overall mean length of stay of 1.1 days. Our copy does not report length of stay separately for the bowel-preparation and no-preparation groups, or the stated mean difference and confidence interval (searched: length of stay, hospital stay, and the stated figures). (LLM, conf=0.72)
Experimental — accuracy not yet measuredThere may be no clinically relevant difference in operating times between women given bowel preparation versus no bowel preparation.
“Based on evidence from a single trial (Sassani 2020), there may be no clinically relevant difference in operating times between women given bowel prep versus no bowel prep (MD 10.20, 95% CI ‐12.83 to 33.23; 1 study, 95 women; low‐certainty evidence; Analysis 5.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Results report 95 women with outcome data and an overall mean operative time of 208.7 minutes, but give no operative times by bowel-preparation group. Searches for operative time and the cited effect estimate found no passage in our copy that establishes the claimed between-group difference or its clinical relevance. (LLM, conf=0.70)
Experimental — accuracy not yet measuredIn Sassani 2020, the risk of reporting bias from selective reporting was low.
“Selective reporting (reporting bias) Low risk Compliant with pre‐trial registration”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Materials and Methods section identifies the primary and secondary outcomes, but our copy does not state that the trial was registered before it began or compare its reported outcomes with a preregistered protocol. Searches for registration, a trial registration number, and selective outcome reporting found no passage supporting the low-risk assessment. The Discussion’s reference to poor compliance concerns participants’ assigned bowel preparation, not trial registration. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn Sassani 2020, the risk of other bias was low.
“Other bias Low risk National Institute Health grant ULITR001857 No conflicts of interest declared”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Sassani 2020
The Discussion (page unavailable) calls poor compliance with randomization a major limitation, but does not assess the study’s risk of ‘other bias.’ Searches for the stated NIH grant, funding, and conflict-of-interest declarations found no matching passage in our copy, so the citing document’s low-risk judgment cannot be verified from it. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Cites
Blake, M. R., Raker, J. M., & Whelan, K. (2016) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13746 · Cited by 495 · see citing works
Psychometric validation of a constipation symptom assessment questionnaire.
Frank, L., Kleinman, L., Farup, C., Taylor, L., & Miner, P. (1999) · Scandinavian Journal of Gastroenterology · doi:10.1080/003655299750025327 · Cited by 459 · see citing works
Slim, K., Vicaut, É., Launay-Savary, M.-V., Contant, C. M. E., & Chipponi, J. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e318193425a · Cited by 360 · see citing works
Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence
Jelovsek, J. E., Barber, M. D., Paraiso, M. F. R., & Walters, M. D. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2005.07.016 · Cited by 127 · see citing works
The PAC ‐ SYM questionnaire for chronic constipation: defining the minimal important difference
Yiannakou, Y., Tack, J. F., Piessevaux, H. H., Dubois, D., Quigley, E. M. M., Ke, M., Silva, S. D., Joseph, A., & Kerstens, R. (2017) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14349 · Cited by 87 · see citing works
Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse
Whitehead, W. E., Bradley, C. S., Brown, M. B., Brubaker, L. T., Gutman, R. E., Varner, R. E., Visco, A. G., Weber, A. M., & Zyczynski, H. M. (2007) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2007.02.046 · Cited by 86 · see citing works
Self-citationPostoperative Activity Restrictions: Any Evidence?
Weir, L. F., Nygaard, I. E., Wilken, J., Brandt, D., & Janz, K. F. (2006) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000197069.57873.d6 · Cited by 76 · see citing works
Muzii, L., Bellati, F., Zullo, M. A., Manci, N., Angioli, R., & Panici, P. B. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.08.049 · Cited by 74 · see citing works
Linder, B. J., Occhino, J. A., Habermann, E. B., Glasgow, A. E., Bews, K. A., & Gershman, B. (2018) · The Journal of Urology · doi:10.1016/j.juro.2018.03.131 · Cited by 68 · see citing works
Yang, L. C., Arden, D., Lee, T. T. M., Mansuria, S., Broach, A., D’Ambrosio, L., & Guido, R. S. (2010) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2010.10.007 · Cited by 43 · see citing works
Mechanical Bowel Preparation Before Laparoscopic Hysterectomy
Siedhoff, M. T., Clark, L. H., Hobbs, K. A., Findley, A. D., Moulder, J. K., & Garrett, J. M. (2014) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000000121 · Cited by 37 · see citing works
Bowel Preparation Before Vaginal Prolapse Surgery: A Randomized Controlled Trial
Ballard, A. C., Parker-Autry, C. Y., Markland, A. D., Varner, R. E., Huisingh, C., & Richter, H. E. (2014) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000081 · Cited by 33 · see citing works
Preoperative Bowel Preparation in Gynecologic Oncology
Wells, T. H., Plante, M., & McAlpine, J. N. (2011) · International Journal of Gynecological Cancer · doi:10.1097/igc.0b013e31821778c4 · Cited by 30 · see citing works
Prevalence of bowel symptoms in women with pelvic floor disorders
Raza-Khan, F., Cunkelman, J. A., Löwenstein, L., Shott, S., & Kenton, K. S. (2010) · International Urogynecology Journal · doi:10.1007/s00192-010-1143-z · Cited by 26 · see citing works
Constipation symptoms before and after vaginal and abdominal pelvic reconstructive surgery
Patel, M. S., O’Sullivan, D. M., & LaSala, C. A. (2011) · International Urogynecology Journal · doi:10.1007/s00192-011-1489-x · Cited by 9 · see citing works
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Sorted by citations
Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations
Altman, A. D., Robert, M., Armbrust, R., Fawcett, W. J., Nihira, M. A., Jones, C. N., Tamussino, K. F., Sehouli, J., Dowdy, S. C., & Nelson, G. S. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.07.039 · Cited by 74 · see citing works
Perioperative interventions in pelvic organ prolapse surgery
Shahid, U., Haya, N., Baessler, K., Christmann-Schmid, C., Yeung, E., Chen, Z., & Maher, C. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013105.pub2 · Cited by 5 · see citing works
Cardaillac, C., Genest, R., Gauthier, C., Arendas, K., Lemyre, M., Laberge, P. Y., Abbott, J. A., & Maheux‐Lacroix, S. (2023) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2023.05.001 · Cited by 5 · see citing works
Chu, L., Liang, J., Wu, S., Xia, J., Li, H., & Tong, X. (2022) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2022.2069002 · Cited by 2 · see citing works
Enhanced Recovery after Surgery in Open Fetal Spina Bifida Repair
Zepf, J., Züger, A., Vonzun, L., Rüegg, L., Strübing, N., Krähenmann, F., Meuli, M., Mazzone, L., Moehrlen, U., Spina Bifida Study Group Zurich, et al. (2024) · Fetal Diagnosis and Therapy · doi:10.1159/000537758 · Cited by 1 · see citing works
- Authors
- Sassani, J. C., Kantartzis, K., Wu, L., Fabio, A., & Zyczynski, H. M.
- Affiliations
- University of Pittsburgh (US)
- University of Arizona (US)
- Corresponding author
- Sassani, Jessica C.
- Venue
- International Urogynecology Journal
- Published
- 2019-11-26
- Volume
- 31
- Issue
- 7
- Pages
- 1305-1313
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC7247935
- OpenAlex
- W2990528709
- Cited by
- 5
- References
- 15
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2020: 1
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001857)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- bowel preparation, postoperative constipation, pelvic organ prolapse surgery, straining during defecation, Bristol stool scale, preoperative bowel preparation
- MeSH terms
- Constipation, Female, Humans, Postoperative Period, Treatment Outcome
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