Polyethylene Glycol 3350 Before Minimally Invasive Hysterectomy: A Randomized Controlled Trial.

o evaluate the efficacy of a pre-operative bowel regimen before minimally invasive hysterectomy, this randomized controlled trial investigated whether a 10-day pre-operative regimen of daily PEG3350 would improve post-operative constipation symptoms as measured using PAC-SYM and PAC-QOL questionnaires. Although the results are limited by an underpowered sample owing to high dropout rates, the PAC-SYM scores were not significantly different between treatment groups, which suggests similar constipation symptoms between groups. The PAC-QOL scores indicated lower satisfaction with their bowel symptoms among the intervention group (those that received pre-operative PEG3350) than the control group. This could be due to a nocebo effect or perhaps patients expecting better constipation outcomes with pre-medication and therefore feeling dissatisfied with their post-operative symptoms. In the future, a blinded study with a placebo group rather than a control group would be of benefit. Other potential explanations for lower quality of life and greater dissatisfaction in the intervention group include potential side effects of the PEG 3350. While baseline constipation, symptom burden, and quality of life scores were similar between groups, these outcomes were not measured before or during the pre-operative intervention. While PEG 3350 is typically well tolerated, some patients may experience abdominal cramping and fatigue from changes in water absorption or mild dehydration. These effects from the pre-operative intervention may not be captured in the post-operative surveys. Pain scores and narcotic usage were not significantly different between treatment groups, nor was time to first bowel movement. These findings suggest a lack of benefit from a potentially unnecessary intervention of a pre-operative bowel regimen and potential harm with lower quality of life in the intervention group.