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. Primary outcomes were POI incidence, time to first flatus, time to solid diet tolerance, patient satisfaction, 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). ERAS plus MOM reduced POI versus ERAS alone (3.8% vs 27.5%; P < 0.001). It also shortened time to first flatus (17.1 ± 7.9 vs 22.3 ± 10.8 hours; P < 0.001). Time to solid diet tolerance was shorter (20.6 ± 10.9 vs 28.8 ± 16.3 hours; P < 0.001). Patient satisfaction scores for eating and daily activities were significantly higher. No severe adverse events occurred in the MOM group. Conclusion Adding MOM to ERAS reduced POI incidence and enhanced postoperative recovery after hysterectomy for benign or malignant disease. Trial registration: Thai Clinical Trials Registry. Registration number 20230816005.