The Surgical Benefit and Pt.Tolerability Between Two Different Bowel Cleansing Regimens Performed Prior to Pelvic Reconstructive Surgery. Does One Bowel Cleansing Regimen Improve the Surgeons Visual Field Significantly Better Than the Other.

Study Overview
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Brief Summary
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Does mechanical bowel preparation (complete bowel cleansing)help the Surgeon with visualization of the operative field during laparoscopic pelvic reconstructive surgery?

Detailed Description
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Patients will be randomized to receive a complete MBP or not prior to their surgical procedure. All patients will use 1 fleets enema the night before surgery and one the morning of surgery to ensure that the rectum is empty of all stool. This will be done since some surgeons use a rectal probe in the rectum to help with manipulation during the procedure. Stool in the rectal vault could contaminate the surgical field and lead to an infection. Patients will be randomized at their pre-op visit and provided instructions according to the group assignment. On the day of surgery patients will be asked to complete a questionnaire in the pre-op holding area to assess their overnight symptoms including insomnia, weakness, abdominal distention, nausea, thirst and overall tolerability of the Bowel Preparation assigned. Immediately after surgery, the primary surgeon will be asked to complete a visual analog score sheet evaluating the ease of the procedure with regard to retraction of the large and small bowel to help with visualization of the sacral promontory, retraction from posterior cul-de-sac, and maintaining adequate positioning after retraction. All surgeons (attendings, fellows, and residents) will be blinded re: the patients group assignment. Each primary surgeon will be asked to assign a final grade to the procedure as easy, medium, or difficult based on overall bowel retraction. At their 2 week follow up visit patients will be asked to report return of bowel function (first bowel movement or flatus) in # of days after surgery and incidents of stool leakage post op.

Official Title
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The Use of Mechanical Bowel Preparation in Pelvic Reconstructive Surgery (MBP)

Conditions
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Pelvic Organ Prolapse

Intervention / Treatment
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* Other: Mechanical Bowel Prep
* Other: No Mechanical Bowel Prep


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients undergoing the following laparoscopic pelvic reconstructive procedures for pelvic organ prolapse: Laparoscopic sacrocervicopexy Laparoscopic sacrocolpopexy Laparoscopic sacrohysteropexy Laparoscopic uterosacral ligament suspension Who understand and are willing to comply with the study requirements, including agreeing to answer the preoperative and postoperative questionnaires Exclusion Criteria: Previous abdominal or laparoscopic colon surgery (not including transrectal procedures) History of abdominal malignancy History of surgical debulking for previous malignancy Non-english speaking Pregnancy Hx of abdomino-pelvic radiation Contraindications to Sodium Phosphate Contraindications to laparoscopic surgery

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Mechanical Bowel Prep<br>Patients randomized to complete a Mechanical Bowel Prep. (complete bowel cleansing) and fleet enemas prior to surgery. | Other: Mechanical Bowel Prep<br>* Patients randomized to MBP will complete procedure per standard instructions.<br>|
| Active Comparator: No Mechanical Bowel Prep.<br>Patients randomized to complete two fleets enemas only prior to surgery. | Other: No Mechanical Bowel Prep<br>* Patient randomized to fleets enemas only prior to surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine whether there is there an added benefit in using a MBP with regard to positioning of the large and small bowel for exposure of key anatomic structures during pelvic reconstructive surgical procedures. | The primary objective of this protocol is to determine whether there is truly an advantage for the surgeon (visually) in having patients complete a Mechanical Bowel Prep prior to surgery or if an enema completed the evening before and morning of the surgery is sufficient. | Surgeons will be asked to complete a questionnaire re: their impressions of the visual field on immediately Post op. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate whether MBP (total bowel cleansing) delays the return of bowel function and/or increases the risk of perioperative leakage of stool (fecal incontinence)post operatively. |  | We will be following the subject from the day of surgery through 2 weeks post op. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mechanical Bowel Prep