Skip to main content

Advertisement

SpringerLink
Log in

Postoperative management and restrictions for female pelvic surgery: a systematic review

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We sought to systematically review the literature regarding the effect of postoperative restrictions on clinical outcomes after pelvic surgery.

Methods

English-language articles were identified by a MEDLINE and Cochrane Central Register of Controlled Trials search from inception to July 2010. We used key words describing various gynecologic surgical procedures and postoperative activities, including mobility, lifting, work, coitus, and exercise. Randomized and nonrandomized studies comparing interventions with outcomes of interest were included.

Results

The literature search yielded of 3,491 articles; 115 full-text articles were reviewed, and 38 met eligibility criteria and are reported and analyzed here. Our analysis revealed that expedited discharge protocols and early postoperative feeding and catheter removal result in shorter hospital stay without negative health outcomes. However, there are limited data to guide many other aspects of postoperative care, particularly regarding exercise and resumption of sexual activity after surgery.

Conclusions

There is good evidence to support early postoperative feeding and catheter removal after pelvic surgery. There are limited data to guide many other aspects of postoperative care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Practice Bulletins – American College of Obstetricians and Gynecologists. Available at: http://www.acog.org/member_access/lists/practbul.cfm

  2. Minig L, Trimble EL, Sarsotti C, Sebastiani MM, Spong CY (2009) Building the evidence base for postoperative and postpartum advise. Obstet Gynecol 114:892–900

    Article  PubMed  Google Scholar 

  3. Owens DK, Lohr KN, Atkins D et al. (2010) AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions–agency for healthcare research and quality and the effective health-care program. J Clin Epidemiol 63(5):513–523

    Article  PubMed  Google Scholar 

  4. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S et al. (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490

    Article  PubMed  Google Scholar 

  5. Jarvis SK, Hallam TK, Lujic S, Abbott JA, Vancaillie TG (2005) Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol 45(4):300–303

    Article  PubMed  Google Scholar 

  6. Maughan K, Clarke D (2001) The effect of a clinical nurse specialist in gynecological oncology on quality of life and sexuality. J Clin Nurs 10:221–229

    Article  PubMed  CAS  Google Scholar 

  7. Bradford A, Meston C (2007) Sexual outcomes and satisfaction with hysterectomy: influence of patient education. J Sex Med 4:106–114

    Article  PubMed  Google Scholar 

  8. Bergman A, Matthews L, Ballard CA (1987) Bladder training after surgery for stress urinary incontinence: is it necessary? Obstet Gynecol 70:909–912

    PubMed  CAS  Google Scholar 

  9. DunnTS SJ, Forshner D (2003) Are in-dwelling catheters necessary for 24 hours after hysterectomy? Am J Obstet Gynecol 189:435–437

    Article  Google Scholar 

  10. Alessandri F, Mistrangelo E, Lijoi D, Ferrero S, Ragni N (2006) A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy. Acta Obstetricia et Gynecologica 85:716–720

    Article  Google Scholar 

  11. Ottesen M, Sorenson M, Kehlet H, Otteson B (2003) Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scan 82:359–366

    Article  Google Scholar 

  12. Gerten KA, Richter HE, Wheeler TL, Pair LS, Burgio KL, Redden DT, Varner E, Hibner M (2008) Intraabdominal pressure changes associated with lifting: implications for postoperative activity restrictions. Am J Obstet Gynecol 198:306e1–306e5

    Article  Google Scholar 

  13. Babski-Reeves KL, Tran GM (2006) Efficacy of an assistive intervention for abdominal surgery patients in postoperative care. Disabil Rehabil Assist Technol 1:191–197

    Article  PubMed  Google Scholar 

  14. Dawes HA, Docherty T, Traynor I, Gilmore DH, Jardine AG, Knill-Jones R (2007) Specialist nurse supported discharge in gynaecology: a randomised comparison and economic evaluation. Eur J Obstet Gynecol Reprod Biol 130(2):262–270

    Article  PubMed  Google Scholar 

  15. Clarke A, Rowe P, Black N (1996) Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England? J Epidemiol Community Health 50:545–550

    Article  PubMed  CAS  Google Scholar 

  16. Broder MS, Bovone S (2002) Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy. J Reprod Med 47(12):999–1003

    PubMed  Google Scholar 

  17. Strong TH, Brown WL Jr, Brown WL, Curry CM (1993) Experience with early postcesarean hospital dismissal. Am J Obstet Gynecol 169:116–119

    PubMed  Google Scholar 

  18. Steed HL, Capstick V, Flood C, Schepansky A, Schultz J, Mayes DC (2002) A randomized trial of early versus “traditional” postoperative oral intake after major abdominal gynecologic surgery. Am J Obstet Gynecol 186(5):861–865

    Article  PubMed  Google Scholar 

  19. Schilder JM, Hurteau JA, Look KY, Moore DH, Raff G, Stehman FB, Sutton GP (1997) A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery. Gynecol Oncol 67(3):235–240

    Article  PubMed  CAS  Google Scholar 

  20. MacMillan SL, Kammerer-Doak D, Rogers RG, Parker KM (2000) Early feeding and the incidence of gastrointestinal symptoms after major gynecologic surgery. Obstet Gynecol 96(4):604–608

    Article  PubMed  CAS  Google Scholar 

  21. Burrows WR, Gingo AJ, Rose SM, Zwick SI, Kosty DL, Dierker LJ, Mann LI (1995) Safety and efficacy of early postoperative solid food consumption after cesarean section. J Reprod Med 40(6):463–467

    PubMed  CAS  Google Scholar 

  22. Soriano D, Dulitzki M, Keidar N, Barkai G, Mashiach S, Sediman DS (1996) Early oral feeding after cesarean delivery. Obstet Gynecol 87(6):1006–1008

    Article  PubMed  CAS  Google Scholar 

  23. Patolia DS, Hilliard RL, Toy EC, Baker B (2001) Early feeding after cesarean: randomized trial. Obstet Gynecol 98(1):113–116

    Article  PubMed  CAS  Google Scholar 

  24. Kovavisarach E, Atthakorn M (2005) Early versus delayed oral feeding after cesarean delivery. Int J Gynaecol Obstet 90(1):31–34

    Article  PubMed  CAS  Google Scholar 

  25. Chantarasorn V, Tannirandorn Y (2006) A comparative study of early postoperative feeding versus conventional feeding for patients undergoing cesarean section; a randomized controlled trial. J Med Assoc Thai 89(4):S11–S16

    PubMed  Google Scholar 

  26. Bar G, Sheiner E, Lezerovizt A, Lazer T, Hallak M (2008) Early maternal feeding following cesarean delivery: a prospective randomized study. Acta Obstet Gynecol Scand 87(1):68–71

    Article  PubMed  Google Scholar 

  27. Mulayim B, Celik NY, Kaya S, Yanik FF (2008) Early oral hydration after cesarean delivery performed under regional anesthesia. Int J Gynaecol Obstet 101(3):273–276

    Article  PubMed  Google Scholar 

  28. Hessov I, Ryley Larsen K, Sondergaard K (1988) Improved early alimentation after radical hysterectomies without the traditional use of stomach tube. Acta Obstet Gynecol Sand 67(3):225–228

    Article  CAS  Google Scholar 

  29. Cutillo G, Maneschi F, Franchi M, Giannice R, Scambia G, Benedetti-Panici P (1999) Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: a randomized study. Obstet Gynecol 93(1):41–45

    Article  PubMed  CAS  Google Scholar 

  30. Feng S, Chen L, Wang G, Chen A, Qiu Y (2008) Early oral intake after intra-abdominal gynecological oncology surgery. Cancer Nurs 31(3):209–213

    Article  PubMed  Google Scholar 

  31. Minig L, Biffi R, Zanagnolo V, Attanasio A, Beltrami C, Bocciolone L et al. (2009) Reduction of postoperative complication rate with the use of early oral feeding in gynecologic oncologic patients undergoing a major surgery: a randomized controlled trial. Ann Surg Oncol 16:3101–3110

    Article  PubMed  Google Scholar 

  32. Pearl ML, Valea FA, Fischer M, Mahler L, Chalas E (1998) A randomized controlled trial of early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol 92(1):94–97

    Article  PubMed  CAS  Google Scholar 

  33. Pearl ML, Frandina M, Mahler L, Valea FA, DiSilvestro PA, Chalas E (2002) A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery. Obstet Gynecol 100(2):230–234

    Article  PubMed  Google Scholar 

  34. Patel M, Schimpf MO, O’Sullivan DM, Lasala CA (2010) The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: a randomized, double-blinded, placebo-controlled trial. Am J Obstet Gynecol 479:e1–e5

    Google Scholar 

  35. Hansen CT, Sorensen M, Moller C, Ottesen B, Kehlet H (2007) Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: a double blind, placebo-controlled randomized study. Am J Obstet Gynecol 196(4):311.e1–7

    Article  Google Scholar 

  36. Demirci F, Somunkiran A, Gul OK, Demiraran Y, Ozdemir I, Gul OB (2007) Does postoperative misoprostol use induce intestinal motility? A prospective randomized double-blind trial. Aust N Z Obstet Gynaecol 47(5):410–414

    Article  Google Scholar 

  37. Fanning J, Yu-Brekke S (1999) Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 73:412–414

    Article  PubMed  CAS  Google Scholar 

  38. Kraus K, Fanning J (2000) Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol 182(5):996–998

    Article  PubMed  CAS  Google Scholar 

  39. Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, Fikry MF (2009) Gum chewing stimulates early return of bowel motility after caesarean section. BJOG 116(10):1334–1339

    Article  PubMed  CAS  Google Scholar 

  40. Mokate T, Wright C, Mander (2006) Hysterectomy and sexual function. J Br Menopause Soc 12(4):153–157

    Article  PubMed  Google Scholar 

  41. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work is presented on behalf of the Society of Gynecologic Surgeons Systematic Review group, with special thanks to Joseph Schaffer MD.

Funding

The Society of Gynecologic Surgeons provided funding support for assistance by methods experts in systematic review and logistic support.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Institute for Female Pelvic Medicine and Reconstructive Surgery, 1010 Horsham Road – Suite 101, North Wales, PA, 19454, USA

    Miles Murphy

  2. State University of New York, Downstate, New York City, NY, USA

    Cedric Olivera

  3. Greenville Hospital System University Medical Group, Greenville, SC, USA

    Thomas Wheeler II

  4. University of Texas Health Science Center, San Antonio, TX, USA

    Elizabeth Casiano

  5. Duke University Medical Center, Durham, NC, USA

    Nazema Siddiqui

  6. Ochsner Clinic Foundation, New Orleans, LA, USA

    Rajiv Gala

  7. Cook County Hospital, Northwestern University, Feinberg School of Medicine Chicago, Chicago, IL, USA

    Tondalaya Gamble

  8. Tufts Medical Center, Boston, MA, USA

    Ethan M. Balk

  9. Women and Infants Hospital of Rhode Island/Alpert Medical School of Brown University, Providence, RI, USA

    Vivian W. Sung

Authors
  1. Miles Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cedric Olivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Wheeler II
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Casiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nazema Siddiqui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rajiv Gala
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tondalaya Gamble
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ethan M. Balk
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vivian W. Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miles Murphy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murphy, M., Olivera, C., Wheeler, T. et al. Postoperative management and restrictions for female pelvic surgery: a systematic review. Int Urogynecol J 24, 185–193 (2013). https://doi.org/10.1007/s00192-012-1898-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1898-5

Keywords

Search

Navigation