Reduction in postoperative ileus rates utilizing lower pressure pneumoperitoneum in robotic-assisted radical prostatectomy.
Rohloff Matthew,Cicic Arman,Christensen Cody,Maatman Thomas K,Lindberg Jeffrey,Maatman Thomas J
Journal of robotic surgery
Robotic-assisted radical prostatectomy (RARP) is the most commonly performed surgery for prostate cancer. This is a study comparing differences in postoperative outcomes between pneumoperitoneum pressures of 15 mmHg and 12 mmHg. Retrospective chart review was performed on 400 patients undergoing RARP over a 5 year period. A combination of Fisher's exact test and ANOVA were utilized for statistical analysis. Age, BMI, Gleason score, positive margin rate, complication rates, blood loss, and operative times were similar in both groups. Length of stay and postoperative ileus rates were significantly less in the 12 mmHg group (p < 0.05). RARP can be safely performed utilizing a lower pressure pneumoperitoneum. Decreasing insufflation pressures from 15 to 12 mmHg can further lead to decreased rates of postoperative ileus.
Coffee to go? The effect of coffee on resolution of ileus following abdominal surgery: A systematic review and meta-analysis of randomised controlled trials.
Cornwall Hannah L,Edwards Ben A,Curran John F,Boyce Stephen
Clinical nutrition (Edinburgh, Scotland)
BACKGROUND & AIMS:Ileus following abdominal surgery is a common postoperative complication. It is a source of considerable morbidity to patients and prolongs hospital stay. There is limited evidence to support the use of coffee to promote resolution of post-operative ileus. METHODS:We performed a systematic review, a risk of bias assessment, and meta-analysis of randomised controlled trials that compared the effect of coffee consumption with control intervention on gastrointestinal motility after abdominal surgery. We searched PubMed, EMBASE, CINAHL, ISI Web of Science, clinicaltrials.gov, Cochrane Library, CENTRAL, WHO ICTRP, and Google Scholar, from inception to 24th February 2018. RESULTS:Data from seven studies were extracted (606 patients). 31% were men. 69% were women. 342 underwent colorectal resection, 114 gynaecological resection and 150 elective caesarean section. Estimates from meta-analysis revealed that coffee consumption reduced time to defecation by 14.8 h (95% CI: -11.9, -17.7) after colorectal resection and 17.8 h (95% CI: -13.6, -22.0) after gynaecological resection, but had no significant effect after caesarean section. Coffee also reduced time to first bowel sound, and time to tolerance of solid food, but not time to first reported flatus. No measures of ileus were increased by coffee consumption. Complications and length of hospital stay were similar for coffee and control groups. Coffee was well-tolerated with no adverse effects. Cost was low. CONCLUSIONS:Risk of bias was moderate or high across studies. Assessed with GRADE criteria, there is low to moderate quality evidence that coffee accelerates postoperative recovery of gastrointestinal function after colorectal and gynaecological surgery. PROSPERO REGISTRATION NUMBER:CRD42018087962.
The use of coffee, chewing-gum and gastrograffin in the management of postoperative ileus: A review of current evidence.
Flores-Funes Diego,Campillo-Soto Álvaro,Pellicer-Franco Enrique,Aguayo-Albasini José Luis
Postoperative ileus is one of the main complications in the postoperative period. New measures appeared with the introduction of «fast-track surgery» to accelerate recovery: coffee, chewing gum and gastrograffin. We performed a summary of current evidence, reviewing articles from MEDLINE, Cochrane Database of Systematic Reviews, ISI Web of Science, and SCOPUS databases. Employed search terms were «postoperative ileus» AND («definition» OR «epidemiology» OR «risk factors» OR «Management»). We selected 44 articles: 9 systematic reviews 11 narrative reviews, 13 randomized clinical trials, 6 observational studies, and the remaining 5 scientific letters, assumptions, etc. There is little literature about this topic, studies are heterogeneous, with disparity in the results. In addition, they only focus on colorectal and gynecological surgery. New high-quality studies are needed, preferably randomized clinical trials, in order to clarify the usefulness of these measures.
Postoperative ileus: Pathophysiology, incidence, and prevention.
Venara A,Neunlist M,Slim K,Barbieux J,Colas P A,Hamy A,Meurette G
Journal of visceral surgery
Postoperative ileus (POI) is a major focus of concern for surgeons because it increases duration of hospitalization, cost of care, and postoperative morbidity. The definition of POI is relatively consensual albeit with a variable definition of interval to resolution ranging from 2 to 7 days for different authors. This variation, however, leads to non-reproducibility of studies and difficulties in interpreting the results. Certain risk factors for POI, such as male gender, advanced age and major blood loss, have been repeatedly described in the literature. Understanding of the pathophysiology of POI has helped combat and prevent its occurrence. But despite preventive and therapeutic efforts arising from such knowledge, 10 to 30% of patients still develop POI after abdominal surgery. In France, pharmacological prevention is limited by the unavailability of effective drugs. Perioperative nutrition is very important, as well as limitation of preoperative fasting to 6 hours for solid food and 2 hours for liquids, and virtually no fasting in the postoperative period. Coffee and chewing gum also play a preventive role for POI. The advent of laparoscopy has led to a significant improvement in the recovery of gastrointestinal function. Enhanced recovery programs, grouping together all measures for prevention or cure of POI by addressing the mechanisms of POI, has reduced the duration of hospitalization, morbidity and interval to resumption of transit.
The Use of Coffee to Decrease the Incidence of Postoperative Ileus: A Systematic Review and Meta-Analysis.
Kane Terri D,Tubog Tito D,Schmidt James R
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
PURPOSE:To investigate the efficacy of providing coffee to elective abdominal surgery patients, immediately postoperatively, to lessen postoperative ileus. DESIGN:A systematic review with meta-analysis of six randomized controlled trials published since 2012. METHODS:Methodological quality was evaluated using the Cochrane guidelines. The Grading of Recommendations, Assessment, Development, and Evaluations assessment tool evaluated the quality of the evidence. Subgroup analyses were completed if the I statistic demonstrated heterogeneity (greater than 50%). FINDINGS:Coffee was statistically significant in shortening the time between surgery and the first passage of stool (mean difference, -9.38; 95% confidence interval, -17.60 to -1.16; P = .03). Although not statistically significant (P = .20), the overall effect favored shorter hospital stays for those patients receiving coffee. CONCLUSIONS:The current systematic review and meta-analysis suggests that coffee given as early as 2 hours postoperatively decreases time to first bowel movement. In addition, patients tolerated solid food faster and were discharged sooner when given coffee immediately postoperatively.
Effectiveness of coffee for postoperative ileus in patients following abdominal surgery: a systematic review protocol.
Kuo Shu-Chen,Mu Pei-Fan,Chang Li-Yin,Chou Shin-Shang,Lee Mei-Yin,Su Jui-Yuan,Shih Chiung-Fen,Curia Marianne
JBI database of systematic reviews and implementation reports
REVIEW QUESTION/OBJECTIVE:The purpose of this systematic review is to critically appraise, synthesize and present the best available evidence concerning the effects of coffee on postoperative ileus following abdominal surgery. The review will consider the effect of coffee and decaffeinated coffee on recovering gastrointestinal function, time to first bowel movement, time to first flatus, time to tolerance of solid food, postoperative complications and length of hospital stay.
[Research advance in causes of postoperative gastrointestinal dysfunction].
Tan Shanjun,Wu Guohao,Yu Wenkui,Li Ning
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
Gastrointestinal dysfunction is a common and major complication after surgery. The syndrome covers a wide spectrum of clinical signs, ranges from mild feeling to severe discomfort and varies from person to person. The mild patients need no care, but severe ones may have long hospital stay, and even suffer from multiple organ dysfunction syndrome, severely affecting postoperative rehabilitation. However, the etiology of postoperative gastrointestinal dysfunction has not been fully elucidated. Much research demonstrates that many factors, such as operative procedures, surgical operation, homeostasis disturbance, anesthesia and analgesia, blood perfusion, inflammation, and neuroendocrine factors, are responsible for the development and progression of postoperative gastrointestinal dysfunction. This study therefore reviewed the causes of postoperative gastrointestinal dysfunction in the published literatures.
Cost and efficacy examination of alvimopan for the prevention of postoperative ileus.
Nemeth Zoltan H,Bogdanovski Dorian A,Paglinco Samantha R,Barratt-Stopper Patricia,Rolandelli Rolando H
Journal of investigative medicine : the official publication of the American Federation for Clinical Research
Opioid analgesics exacerbate ileus through peripheral μ-opioid receptor action. Alvimopan, a μ-opioid receptor antagonist, has been proposed to alleviate postoperative ileus, leading to decreased time to return of gastrointestinal function and hospital discharge. As opioid-induced motility issues are only one factor affecting postoperative ileus, continued examination of the cost of the use and efficacy of the drug is needed. Data for this study were collected retrospectively from the charts of 55 patients who received an anastomosis and were given alvimopan at Morristown Medical Center between 2010 and 2013 as well as from 58 appropriately matched controls. The billing record and chart for each patient was examined, and information on total hospital charges, age, sex, body mas index, primary diagnosis, procedure type, length of stay (days), time to return of bowel function (hours), and outcomes were recorded for analysis. No difference between patients given alvimopan and controls was observed for the length of hospital stay (4.6 vs 4.8 days) or for time to return of bowel function (68.5 vs 67.3 hours). Total hospital charges were higher for treated patients (p=0.0080), averaging $48 705.15 and $41 068.80, respectively. Alvimopan was not associated with improved clinical outcome but was associated with an increase in hospital charges within this population.
Chewing gum for postoperative recovery of gastrointestinal function.
Short Vaneesha,Herbert Georgia,Perry Rachel,Atkinson Charlotte,Ness Andrew R,Penfold Christopher,Thomas Steven,Andersen Henning Keinke,Lewis Stephen J
The Cochrane database of systematic reviews
BACKGROUND:Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay (LOHS). Onset of ileus is considered to be multifactorial, and a variety of preventative methods have been investigated. Chewing gum (CG) is hypothesised to reduce postoperative ileus by stimulating early recovery of gastrointestinal (GI) function, through cephalo-vagal stimulation. There is no comprehensive review of this intervention in abdominal surgery. OBJECTIVES:To examine whether chewing gum after surgery hastens the return of gastrointestinal function. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), MEDLINE (via PubMed), EMBASE (via Ovid), CINAHL (via EBSCO) and ISI Web of Science (June 2014). We hand-searched reference lists of identified studies and previous reviews and systematic reviews, and contacted CG companies to ask for information on any studies using their products. We identified proposed and ongoing studies from clinicaltrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform and metaRegister of Controlled Trials. SELECTION CRITERIA:We included completed randomised controlled trials (RCTs) that used postoperative CG as an intervention compared to a control group. DATA COLLECTION AND ANALYSIS:Two authors independently collected data and assessed study quality using an adapted Cochrane risk of bias (ROB) tool, and resolved disagreements by discussion. We assessed overall quality of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Studies were split into subgroups: colorectal surgery (CRS), caesarean section (CS) and other surgery (OS). We assessed the effect of CG on time to first flatus (TFF), time to bowel movement (TBM), LOHS and time to bowel sounds (TBS) through meta-analyses using a random-effects model. We investigated the influence of study quality, reviewers' methodological estimations and use of Enhanced Recovery After Surgery (ERAS) programmes using sensitivity analyses. We used meta-regression to explore if surgical site or ROB scores predicted the extent of the effect estimate of the intervention on continuous outcomes. We reported frequency of complications, and descriptions of tolerability of gum and cost. MAIN RESULTS:We identified 81 studies that recruited 9072 participants for inclusion in our review. We categorised many studies at high or unclear risk of the bias' assessed. There was statistical evidence that use of CG reduced TFF [overall reduction of 10.4 hours (95% CI: -11.9, -8.9): 12.5 hours (95% CI: -17.2, -7.8) in CRS, 7.9 hours (95% CI: -10.0, -5.8) in CS, 10.6 hours (95% CI: -12.7, -8.5) in OS]. There was also statistical evidence that use of CG reduced TBM [overall reduction of 12.7 hours (95% CI: -14.5, -10.9): 18.1 hours (95% CI: -25.3, -10.9) in CRS, 9.1 hours (95% CI: -11.4, -6.7) in CS, 12.3 hours (95% CI: -14.9, -9.7) in OS]. There was statistical evidence that use of CG slightly reduced LOHS [overall reduction of 0.7 days (95% CI: -0.8, -0.5): 1.0 days in CRS (95% CI: -1.6, -0.4), 0.2 days (95% CI: -0.3, -0.1) in CS, 0.8 days (95% CI: -1.1, -0.5) in OS]. There was statistical evidence that use of CG slightly reduced TBS [overall reduction of 5.0 hours (95% CI: -6.4, -3.7): 3.21 hours (95% CI: -7.0, 0.6) in CRS, 4.4 hours (95% CI: -5.9, -2.8) in CS, 6.3 hours (95% CI: -8.7, -3.8) in OS]. Effect sizes were largest in CRS and smallest in CS. There was statistical evidence of heterogeneity in all analyses other than TBS in CRS.There was little difference in mortality, infection risk and readmission rate between the groups. Some studies reported reduced nausea and vomiting and other complications in the intervention group. CG was generally well-tolerated by participants. There was little difference in cost between the groups in the two studies reporting this outcome.Sensitivity analyses by quality of studies and robustness of review estimates revealed no clinically important differences in effect estimates. Sensitivity analysis of ERAS studies showed a smaller effect size on TFF, larger effect size on TBM, and no difference between groups for LOHS.Meta-regression analyses indicated that surgical site is associated with the extent of the effect size on LOHS (all surgical subgroups), and TFF and TBM (CS and CRS subgroups only). There was no evidence that ROB score predicted the extent of the effect size on any outcome. Neither variable explained the identified heterogeneity between studies. AUTHORS' CONCLUSIONS:This review identified some evidence for the benefit of postoperative CG in improving recovery of GI function. However, the research to date has primarily focussed on CS and CRS, and largely consisted of small, poor quality trials. Many components of the ERAS programme also target ileus, therefore the benefit of CG alongside ERAS may be reduced, as we observed in this review. Therefore larger, better quality RCTS in an ERAS setting in wider surgical disciplines would be needed to improve the evidence base for use of CG after surgery.
Effect of postoperative coffee consumption on gastrointestinal function after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials.
Eamudomkarn Nuntasiri,Kietpeerakool Chumnan,Kaewrudee Srinaree,Jampathong Nampet,Ngamjarus Chetta,Lumbiganon Pisake
Coffee is believed to prevent postoperative ileus. This systematic review and meta-analysis was undertaken to determine the effectiveness of coffee consumption in stimulating gastrointestinal function after abdominal surgery. A number of databases for randomized controlled trials comparing coffee consumption following abdominal surgery versus water drinking or no intervention were searched. Cochrane's Risk of Bias tool was used to assess risk of bias in included studies. Six trials involving 601 participants were included. All studies had high risk of performance bias. Three studies had an unclear risk of selection bias. Postoperative coffee consumption reduced time to first defecation (mean difference (MD), -9.98 hours; 95% CI, -16.97 to -2.99), time to first flatus (MD, -7.14 hours; 95% CI, -10.96 to -3.33), time to first bowel sound (MD, -4.17 hours; 95% CI, -7.88 to -0.47), time to tolerance of solid food (MD, -15.55 hours; 95% CI, -22.83 to -8.27), and length of hospital stay (MD, -0.74 days; 95% CI, -1.14 to -0.33). Benefits increased with increasing complexity of the procedure. None of the included studies reported adverse events associated with coffee consumption. Postoperative coffee consumption is effective and safe for enhancing the recovery of gastrointestinal function after abdominal surgery.
Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis.
Wen Bei,Wang Yajie,Zhang Cong,Fu Zhijian
BACKGROUND:The return of gastrointestinal function is an important sign of postoperative recovery in patients undergoing surgery with general anaesthesia. We aimed to summarize the effects of stellate ganglion block on the recovery of gastrointestinal function as a means of exploring methods through which anaesthesiologists can contribute to postoperative patient recovery. METHODS:We performed a quantitative systematic review of randomized controlled trials published between January 1, 1988, and November 11, 2019, in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, and the Wanfang and SinoMed databases. Study quality was assessed by using the GRADE criteria and bias of included studies were assessed using the revised Cochrane risk-of-bias tool for randomized trials. The time to peristaltic sound resumption, flatus, postoperative eating and the incidence of abdominal bloating in the stellate ganglion block and control groups were compared. The control group consisted of either a stellate ganglion block with normal saline or no treatment. Meta-analysis was performed using Review Manager software. RESULTS:After searching for relevant articles, 281 studies were identified, and five articles with data on 274 patients were eligible. Regarding postoperative flatus time, stellate ganglion block resulted in a mean reduction of 15 h (P = 0.02); then a sensitivity analysis was performed, and the standard mean difference decreased to 6 h (P = 0.007). For gastrointestinal surgery, the mean reduction was 23.92 h (P = 0.0002). As for the evaluation of the recovery of peristaltic sounds, stellate ganglion block promoted the recovery of regular peristaltic bowel sounds an average of 14.67 h earlier than in the control (P = 0.0008). When it comes to nutrients, stellate ganglion block shortened the total parenteral nutrition time by more than 50 h in patients who had undergone gastrointestinal surgery (P<0.00001). Finally, stellate ganglion block prevented the occurrence of postoperative abdominal bloating (P = 0.001).) No complications related to stellate ganglion block were reported. CONCLUSION:Stellate ganglion block may promote postoperative gastrointestinal recovery in patients undergoing various surgeries under general anaesthesia. However, additional trials investigating the use of stellate ganglion block are necessary to confirm our finding. TRIAL REGISTRATION:This meta-analysis has been registered at the International Prospective Register of Systematic Reviews (registration number CRD42020157602).
Effect of Intraoperative Dexmedetomidine on Recovery of Gastrointestinal Function After Abdominal Surgery in Older Adults: A Randomized Clinical Trial.
Lu Yao,Fang Pan-Pan,Yu Yong-Qi,Cheng Xin-Qi,Feng Xiao-Mei,Wong Gordon Tin Chun,Maze Mervyn,Liu Xue-Sheng,
JAMA network open
Importance:Postoperative ileus is common after abdominal surgery, and small clinical studies have reported that intraoperative administration of dexmedetomidine may be associated with improvements in postoperative gastrointestinal function. However, findings have been inconsistent and study samples have been small. Further examination of the effects of intraoperative dexmedetomidine on postoperative gastrointestinal function is needed. Objective:To evaluate the effects of intraoperative intravenous dexmedetomidine vs placebo on postoperative gastrointestinal function among older patients undergoing abdominal surgery. Design, Setting, and Participants:This multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at the First Affiliated Hospital of Anhui Medical University in Hefei, China (lead site), and 12 other tertiary hospitals in Anhui Province, China. A total of 808 participants aged 60 years or older who were scheduled to receive abdominal surgery with an expected surgical duration of 1 to 6 hours were enrolled. The study was conducted from August 21, 2018, to December 9, 2019. Interventions:Dexmedetomidine infusion (a loading dose of 0.5 μg/kg over 15 minutes followed by a maintenance dose of 0.2 μg/kg per hour) or placebo infusion (normal saline) during surgery. Main Outcomes and Measures:The primary outcome was time to first flatus. Secondary outcomes were postoperative gastrointestinal function measured by the I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) scoring system, time to first feces, time to first oral feeding, incidence of delirium, pain scores, sleep quality, postoperative nausea and vomiting, hospital costs, and hospital length of stay. Results:Among 808 patients enrolled, 404 were randomized to receive intraoperative dexmedetomidine, and 404 were randomized to receive placebo. In total, 133 patients (60 in the dexmedetomidine group and 73 in the placebo group) were excluded because of protocol deviations, and 675 patients (344 in the dexmedetomidine group and 331 in the placebo group; mean [SD] age, 70.2 [6.1] years; 445 men [65.9%]) were included in the per-protocol analysis. The dexmedetomidine group had a significantly shorter time to first flatus (median, 65 hours [IQR, 48-78 hours] vs 78 hours [62-93 hours], respectively; P < .001), time to first feces (median, 85 hours [IQR, 68-115 hours] vs 98 hours [IQR, 74-121 hours]; P = .001), and hospital length of stay (median, 13 days [IQR, 10-17 days] vs 15 days [IQR, 11-18 days]; P = .005) than the control group. Postoperative gastrointestinal function (as measured by the I-FEED score) and delirium incidence were similar in the dexmedetomidine and control groups (eg, 248 patients [72.1%] vs 254 patients [76.7%], respectively, had I-FEED scores indicating normal postoperative gastrointestinal function; 18 patients [5.2%] vs 12 patients [3.6%] had delirium on postoperative day 3). Conclusions and Relevance:In this randomized clinical trial, the administration of intraoperative dexmedetomidine reduced the time to first flatus, time to first feces, and length of stay after abdominal surgery. These results suggest that this therapy may be a viable strategy to enhance postoperative recovery of gastrointestinal function among older adults. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR1800017232.
Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy.
Lin Chunhua,Wan Fengchun,Lu Youyi,Li Guojun,Yu Luxin,Wang Meng
The Journal of international medical research
OBJECTIVE:To determine the value of an enhanced recovery after surgery (ERAS) protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy (LRP). METHODS:We conducted a retrospective cohort study using clinical data for 288 patients who underwent LRP in our hospital from June 2010 to December 2016. A total of 124 patients underwent ERAS (ERAS group) and the remaining 164 patients were allocated to the control group. ERAS comprised prehabilitation exercise, carbohydrate fluid loading, targeted intraoperative fluid resuscitation and keeping the body warm, avoiding drain use, early mobilization, and early postoperative drinking and eating. RESULTS:The times from LRP to first water intake, first ambulation, first anal exhaust, first defecation, pelvic drainage-tube removal, and length of hospital stay (LOS) were all significantly shorter, and hospitalization costs and the incidence of postoperative complications were significantly lower in the ERAS group compared with the control group. No deaths or reoperations occurred in either group, and there were no readmissions in the ERAS group, within 90 days after surgery. CONCLUSION:ERAS protocols may effectively accelerate patient rehabilitation and reduce LOS and hospitalization costs in patients undergoing LRP.
Rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes postoperative gastrointestinal function recovery.
Cao Li-Xing,Chen Zhi-Qiang,Jiang Zhi,Chen Qi-Cheng,Fan Xiao-Hua,Xia Shi-Jun,Lin Jin-Xuan,Gan Hua-Chan,Wang Tao,Huang Yang-Xue
World journal of gastroenterology
BACKGROUND:During the perioperative period, the characteristic therapy of traditional Chinese medicine is effective in improving postoperative rehabilitation. In large-scale hospitals practicing traditional Chinese medicine, there is accumulating experience related to the promotion of fast recovery in the perioperative period. AIM:To evaluate the efficacy and safety of Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique. METHODS:This prospective, multicenter, randomized, controlled study included two groups: Treatment group and control group. The patients in the treatment group and control group received Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique and routine treatment, respectively. Clinical observation regarding postoperative recovery of gastrointestinal function was performed, including the times to first passage of flatus, first defecation, and first normal bowel sounds. The comparison between groups was conducted through descriptive analysis, , , and rank-sum tests. RESULTS:There was a statistically significant difference in the time to postoperative first defecation between the treatment and control group (87.16 ± 32.09 109.79 ± 40.25 h, respectively; < 0.05). Similarly, the time to initial recovery of bowel sounds in the treatment group was significantly shorter than that in the control group (61.17 ± 26.75 79.19 ± 33.35 h, respectively; < 0.05). However, there was no statistically significant difference in the time to initial exhaust between the treatment and control groups (51.54 ± 23.66 62.24 ± 25.95 h, respectively; > 0.05). The hospitalization expenses for the two groups of patients were 62283.45 ± 12413.90 and 62059.42 ± 11350.51 yuan, respectively. Although the cost of hospitalization was decreased in the control group, the difference was not statistically significant ( > 0.05). This clinical trial was safe without reports of any adverse reaction or event. CONCLUSION:The rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes the recovery of postoperative gastrointestinal function and is significantly better than standard approach for patients after colorectal surgery.
Enhanced recovery after surgery promotes the postoperative recovery of lung and gastrointestinal function of pseudomyxoma peritonei.
Kuang Xuechun,She Guie,Shi Yanhui,Liu Shuang,Nie Lijun,Tang Hongying
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences
OBJECTIVES:Pseudomyxoma peritonei (PMP) is a rare low-grade malignant tumor, which is difficult to operate with many postoperative complications. In recent years, enhanced recovery after surgery (ERAS) has been greatly developed in the perioperative management of surgical diseases, and it plays an important role in improving the postoperative prognosis of surgical patients. This study was conducted to explore the application of ERAS in the perioperative management of PMP patients, and to study the effect of ERAS on postoperative respiratory and digestive tract complications. METHODS:We retrospectively analyzed clinical data of patients with PMP from January 2014 to December 2018. These patients were treated with surgery in our center and they were divided into an observation group and a control group. The patients in the control group didn't perform ERAS in perioperative period, and patients in the observation group was performed ERAS. Then, we analyzed and compared the postoperative pulmonary complications (PPC) and gastrointestinal function between the 2 groups. RESULTS:There was no significant difference in the incidence of atelectasis, pleural effusion, pulmonary infection and acute respiratory distress syndrome (ARDS) between the two groups, but the total incidence of PPC in the observation group was significantly lower than that in the control group (=0.032). The incidence of postoperative gastrointestinal dysfunction (PGID) in the observation group was significantly lower than that in the control group (=0.025), and the postoperative first exhaust time, first defecation time, oral feeding time, and albumin level in the observation group were all better than those in the control group (all <0.05). CONCLUSIONS:ERAS can significantly reduce the incidence of postoperative PPC and PGID in the PMP patients and improve their postoperative recovery.