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Bowel Preparation for Major Surgery

As malignant pelvic tumors arising from the ovary or fallopian tube commonly involve the small or large bowel, preparation of the bowel prior to an operative intervention is essential.

Patients should be held to reduce their oral intake to clear fluids only, 36 hours prior to the intervention. The bowel preparation should be performed on the afternoon of the day prior to the proposed surgery. 15 mg of Maxeran should be given orally, ½ hour before commencing with the bowel preparation.

For patients with a high likelihood of advanced or metastatic ovarian cancer presenting with a fixed pelvic mass and/or ascites and/or evidence of upper abdominal disease, should undergo gastrointestinal lavage with an electrolyte solution prepared specifically for this purpose. Typically this consists of a powdered electrolyte preparation which is supplied with a 4.8 liter jug. Four liters of water are added to the powder to make up the total volume of 4.8 liters.

Patients that have a low likelihood of advanced or metastatic cancer or that are unable to tolerate the above regimen should substitute the electrolyte solution for two bottles of 295 ml magnesium citrate solution USP. In addition to that the patient should receive two tablets of phenolphthalein, 130 mg each, as well as a suppository of 10 mg bisacodyl USP.

At the time of start of the operative procedure the patient should receive 80 mg of gentamycin intravenously and 500 mg of Flagyl intravenously.

Please note that the use of enemas is no substitute for the above bowel preparation regimens.