Milk of magnesia in enhanced recovery after surgery for preventing postoperative ileus after hysterectomy: randomized controlled trial

PURPOSE: To evaluate whether adding milk of magnesia (MOM) to an enhanced recovery after surgery (ERAS) pathway prevents postoperative ileus (POI) and improves postoperative bowel function. METHODS: This randomized controlled trial at the Gynecology Unit, Siriraj Hospital (Bangkok, Thailand) enrolled patients undergoing hysterectomy for benign or malignant indications during September 2023 through February 2024. Participants were randomly assigned to ERAS alone (n = 80) or ERAS plus MOM (n = 80). The MOM group received 15 mL on postoperative day 0 and then 30 mL twice daily until first flatus or bowel movement. The primary outcome was the time from surgery to resumption of a well-tolerated solid diet. Secondary outcomes included POI incidence, time to first flatus, patient-reported outcomes, and MOM-related complications. RESULTS: Among 160 patients, 60 (37.5%) had gynecologic malignancies: endometrial cancer (n = 34), ovarian cancer (n = 16), cervical cancer (n = 8), and leiomyosarcoma (n = 2). Time to well-tolerated solid diet was significantly shorter in the MOM group compared with the control group (20.6 ± 10.9 vs 28.8 ± 16.3 h; P < 0.001). The incidence of POI was also significantly lower (3.8% vs 27.5%; P < 0.001), and time to first flatus was shorter (17.1 ± 7.9 vs 22.3 ± 10.8 h; P < 0.001). Patient-reported outcomes favored the MOM group, with higher eating and daily activity satisfaction scores. No severe adverse events occurred in the MOM group. CONCLUSION: Adding MOM to ERAS was associated with reduced POI incidence and faster recovery of bowel function in patients undergoing abdominal hysterectomy for benign or malignant conditions. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR: TCTR20230816005), registered on 16 August 2023.