Pre-Operative Bowel Preparation

The preoperative bowel preparation is an essential step in enabling the complete and safe removal of all areas of disease during one procedure.Dr. Cook

Dr. Cook requires that all patients undergoing endometriosis surgery have a preoperative bowel prep the evening before surgery. He does this for your safety during surgery and to facilitate the best surgical outcomes.

Preoperative bowel preparation is the process of taking a special laxative drink, tablets and/or enema in order to fully eliminate the content of the bowel in preparation for surgery. The bowel prep is completed by the patient at home the evening prior to her procedure.

Undergoing a bowel prep is an inconvenient and unpleasant process – some patients say it is “worse” than the surgery itself. The laxative drink may be difficult to palate due to its unpleasant taste, you may experience cramping pain of your intestines and you will spend some hours going back and forth to the bathroom until your bowels are fully evacuated. You will also need to adhere to a clear liquid diet the day prior to surgery. Patients may wonder why they are going through this ordeal when not all gynecologists request it prior to surgery. The answer is that it is a necessary “evil” for safe and effective endometriosis surgery.

1. Bowel preparation aids in visual inspection and diagnosis of any endometriosis present. If the bowel is full of stool, it gets in the way of seeing the entire pelvic area, and can therefore hamper the surgeon’s ability to carefully inspect all areas for the presence of disease.

2. Bowel preparation is necessary for the complete removal of invasive bowel endometriosis. If endometriosis is growing on the bowel, it must be removed. Occasionally endometriosis penetrates through the bowel wall and, in the process of removal, a hole must be made in the bowel. If the patient has completed a bowel prep, the bowel can be safely repaired laparoscopically, with minimal risk of contaminating the pelvis. When endometriosis completely invades a large area of bowel, the entire affected segment of bowel must be removed and the two loose ends reconnected. Again, the bowel should be clean in order to perform this procedure safely. In the absence of a preoperative bowel prep, this procedure would need to be postponed until a later surgery with the required preoperative bowel preparation. Even if the bowel is not involved by disease, occasionally damage may occur to the bowel during complex surgery, such as when the bowel is fused to surrounding organs by dense scar tissue. In such situations, if the bowel is clean, any damage can be safely and uneventfully repaired during the surgery.

Bowel preparation is therefore an essential step in enabling the complete and safe removal of all areas of disease during one procedure. It is definitely worth the inconvenience of undergoing the prep in order to obtain the best outcomes from your surgery. If your surgeon does not order a prep prior to your endometriosis surgery, it may be worth asking why.

Further reading
A survival guide to bowel preps