Use of Intraoperative Bowel Preparation in Gynecological Surgery—A Technical Summary

Objective: Mechanical bowel preparation (MBP) in combination with preoperative oral antibiotics is recommended for elective colorectal surgery. There are numerous reasons why this may not be adequate preoperatively. This article and video outline a technique for intraoperative bowel preparation. Methods: The technique for intraoperative bowel preparation is delineated in the case presentation, in which sigmoid resection was necessary as part of an en bloc procedure for an ovarian malignancy. Preoperative preparation was not deemed adequate for sigmoid resection and reanastomosis without a proximal diversion. Results: The surgical steps that are delineated are: (1) resection of the diseased portion of the colon with a surgical stapling device; (2) adequate mobilization of the proximal and distal colon; (3) cannulization of the proximal resected end of the colon for bowel effluent off of the surgical field; (4) placement of an irrigation cannula in the cecum for the irrigation solution with antibiotics; (5) irrigation of the distal rectosigmoid and rectum either transanally or in an antegrade fashion if this is not possible; (6) removal of the cannulas with closure of the cecostomy; and (7) colon reanastomosis. Conclusions: We present a technique for intraoperative bowel preparation in patients with inadequate preoperative preparation. In our patient, there was primary healing without surgical site infection or anastomotic leak and no need for a diverting loop procedure. The patient had a return of normal bowel function.