Management of Gastrointestinal Function in Patients After Laparoscopic Surgery for Benign Gynaecological Diseases: A Best Practice Implementation Project.

introductionLaparoscopy is widely used in benign gynaecological surgeries. However, postoperative gastrointestinal dysfunction, abdominal distension, abdominal pain, nausea, vomiting and delayed defecation are often negatively affected after surgery. At present, the management of gastrointestinal function in these patients is not standardised; therefore, this project used the available evidence to improve awareness and practice of standardised management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases.

objectivesThis project aimed to standardise the management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases according to best practice.

methodsThis study used clinical audit strategies under the JBI Practical Application of Clinical Evidence System (JBI PACES) module. An audit-feedback cycle was used from September 2023 to December 2023. Twenty-seven best practice recommendations were used for the audit cycle, and the baseline audit was conducted using 15 nurses and 45 patients in a gynaecological surgery ward. The Getting Research into Practice audit and feedback tool was used to identify the barriers, strategies, resources and outcomes. After implementing evidence-based strategies, a re-audit was conducted following the same number of samples and criteria. We analysed compliance with best practice and its impact on the degree of abdominal distension 24 h after the operation, the first flatus time and the first defecation time after surgery.

resultsAfter implementing best-practice strategies, the compliance rate of the 27 criteria was as follows: the implementation rate of indicators 1, 2, 3, 4, 8, 9, 11, 12, 13, 14 and 18 remained above 80%, among which the implementation rates of indicators 1, 2, 3, 11, 12, 13, 14 and 18 reached 100%. The implementation rates of criteria 5, 6, 7, 10, 15, 19-27 had all improved, among which the implementation rate of criteria 6, 7, 19, 22, 23, 24 reached 100%, criteria 5, 10, 15, 16, 17, 20, 21, 25, 26, 27 were 93.56%, 90.89%, 6.67%, 87.89%, 70.56%, 86.40%, 88.89%, 60.67%, 70.89%, 78.60%, respectively. In the follow-up audit cycle, the time of patients' first postoperative anal exhaust (Z = -4.810, p < 0.001) was shorter than the baseline audit group, the time of patients' first postoperative defecation time (Z = -2.934, p < 0.01) was shorter than the baseline audit group, and the degree of abdominal distension (Z = -2.567, p = 0.010 < 0.05) was reduced than the baseline audit group, which all showed statistically significant.

conclusionsThe results indicate that evidence-based practice has significantly improved the management of gastrointestinal function in patients after laparoscopic surgery for benign gynaecological diseases, improved the implementation rate of audit criteria, shortened the time of first flatus and defecation and reduced the degree of abdominal distension after surgery.