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Lehane A, Perez M, Smith C, Tian Y, Holl JL, Raval MV. Slow Down Fluids to Speed Up the Intestine - Exploring Postoperative Ileus in Pediatric Gastrointestinal Surgery. J Pediatr Surg 2025; 60:162153. [PMID: 39805721 DOI: 10.1016/j.jpedsurg.2024.162153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/02/2024] [Accepted: 12/30/2024] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Postoperative ileus is a known complication of gastrointestinal (GI) surgery. In adult populations, ileus is associated with higher amounts of intraoperative intravenous (IV) fluids. This study examines the relationship between intraoperative IV fluids and postoperative ileus in pediatric patients undergoing GI surgery. METHODS The cohort, part of an 18-center prospective trial of the implementation of an enhanced recovery protocol, consists of patients (ages 10-18 years) undergoing non-emergent GI surgery. Statistical analysis compared patients with and without postoperative ileus within 30 days of surgery, stratified by receipt of intraoperative IV fluids. RESULTS Of 553 patients, 39 (7 %) had postoperative ileus. Patients with ileus received a higher mean amount (1453 ± 1219.7 mL vs. 1180 ± 838.7 mL, p = 0.02) of intraoperative IV crystalloid fluid and at a higher rate (9.2 mL/kg/h vs. 7.4 mL/kg/h, p = 0.03) compared to those who did not. Only 4 % of patients receiving less than 5 mL/kg/h had ileus, 6.3 % if receiving 6 mL/kg/h to 10 mL/kg/h, and 13.6 % if receiving >10 mL/kg/h. Patients with ileus had a longer length of stay compared to those who did not (11.3 ± 10.7 days, vs. 4.9 ± 6.2 days, p < 0.001). There were no statistically significant differences in reason for surgery, type of surgery, American Society of Anesthesiologists (ASA) score, preoperative opioid use, operative technique, or type of anastomosis. CONCLUSION Postoperative ileus in pediatric patients undergoing GI surgery is associated with higher amounts and rates of intraoperative IV fluids. Limiting intraoperative fluids is a key target for enhanced recovery protocols in children.
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Affiliation(s)
- Alison Lehane
- Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, USA.
| | - Mallory Perez
- Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, USA
| | - Charesa Smith
- Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, USA
| | - Yao Tian
- Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, Biological Science Division, University of Chicago, USA
| | - Mehul V Raval
- Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, USA
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Animaw FC, Asresie MB, Endeshaw AS. Postoperative ileus and associated factors in patients following major abdominal surgery in Ethiopia: a prospective cohort study. BMC Surg 2025; 25:102. [PMID: 40098131 PMCID: PMC11912789 DOI: 10.1186/s12893-025-02839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 03/12/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Postoperative ileus is a complication of abdominal surgery, resulting in significant morbidity and patient discomfort, dissatisfaction, and great economic burden. However, clinical studies regarding POI are very limited in Ethiopia and other Sub-Saharan countries. The main objective of this study is to assess the incidence and associated factors of postoperative ileus among adult patients who underwent abdominal surgery at hospitals in Northwest Ethiopia. METHODS AND MATERIALS A multicenter hospital-based prospective cohort study was conducted on patients who underwent major abdominal surgeries at specialized hospitals in Bahir Dar from November 20, 2023, to January 20, 2024. A total of 252 were selected by consecutive sampling techniques and included in the final analysis. Data were collected using EpidData version n4.6 and analyzed by STATA version 17. Bivariable and multivariable binary logistic regression were fitted to identify the explanatory variables. RESULTS The incidence of postoperative ileus at hospitals in Bahir Dar was 16.27% (95% CI: 12.19%, 21.38%). Age > 60 years (adjusted odds ratio (AOR) = 3.81, 95% CI: 1.41, 10.33), BMI < 18.5 kg/m² (AOR = 11.54, 95% CI: 67.55), and intestinal surgery (AOR = 3.27, 95% CI: 1.01, 11.77) were significantly associated with postoperative ileus. On the other hand, being female was associated with a decreased likelihood of postoperative ileus (AOR = 61%, AOR = 0.39, 95% CI: 0.15, 0.97). CONCLUSION Postoperative ileus among patients who underwent major abdominal surgery in Bahir Dar was comparable with global reports. Old age, low body mass index, and intestinal surgeries were significant determinant factors for postoperative ileus. Being female is associated with a decreased likelihood of postoperative ileus.
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Affiliation(s)
- Fasika Chanie Animaw
- Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Zeng HP, Cao LX, Diao DC, Wen ZH, Ouyang WW, Ou AH, Wan J, Peng ZJ, Wang W, Chen ZQ. Efficacy of Wuda Granule on Recovery of Gastrointestinal Function after Laparoscopic Bowel Resection: A Randomized Double-Blind Controlled Trial. Chin J Integr Med 2024; 30:1059-1067. [PMID: 39251465 DOI: 10.1007/s11655-024-3813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Wuda Granule (WDG) on recovery of gastrointestinal function after laparoscopic bowel resection in the setting of enhanced recovery after surgery (ERAS)-based perioperative care. METHODS A total of 108 patients aged 18 years or older undergoing laparoscopic bowel resection with a surgical duration of 2 to 4.5 h were randomly assigned (1:1) to receive either WDG or placebo (10 g/bag) twice a day from postoperative days 1-3, combining with ERAS-based perioperative care. The primary outcome was time to first defecation. Secondary outcomes were time to first flatus, time to first tolerance of liquid or semi-liquid food, gastrointestinal-related symptoms and length of stay. Subgroup analysis of the primary outcome according to sex, age, tumor site, surgical time, histories of underlying disease or history of abdominal surgery was undertaken. Adverse events were observed and recorded. RESULTS A total of 107 patients [53 in the WDG group and 54 in the placebo group; 61.7 ± 12.1 years; 50 males (46.7%)] were included in the intention-to-treat analysis. The patients in the WDG group had a significantly shorter time to first defecation and flatus [between-group difference -11.01 h (95% CI -20.75 to -1.28 h), P=0.012 for defecation; -5.41 h (-11.10 to 0.27 h), P=0.040 for flatus] than the placebo group. Moreover, the extent of improvement in postoperative gastrointestinal-related symptoms in the WDG group was significantly better than that in the placebo group (P<0.05). Subgroup analyses revealed that the benefits of WDG were significantly superior in patients who were male, or under 60 years old, or surgical time less than 3 h, or having no history of basic disease or no history of abdominal surgery. There were no serious adverse events. CONCLUSION The addition of WDG to an ERAS postoperative care may be a viable strategy to enhance gastrointestinal function recovery after laparoscopic bowel resection surgery. (Registry No. ChiCTR2100046242).
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Affiliation(s)
- Hai-Ping Zeng
- Department of Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Li-Xing Cao
- Center of Traditional Chinese Medicine Applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - De-Chang Diao
- Department of Colorectal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Ze-Huai Wen
- Key Unit of Methodology in Clinical Research, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, 510120, China
| | - Wen-Wei Ouyang
- Key Unit of Methodology in Clinical Research, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Global Public Health, Karolinska Institute, Stockholm, 17176, Sweden
| | - Ai-Hua Ou
- Department of Big Data Research of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Jin Wan
- Gastrointestinal Cancer Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Zhi-Jun Peng
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Wei Wang
- Department of Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Zhi-Qiang Chen
- Center of Traditional Chinese Medicine Applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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Shi S, Lu C, Shan L, Yan L, Liang Y, Feng T, Chen Z, Chen X, Wu X, Liu SD, Duan XL, Wang ZZ. Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning. World J Gastrointest Surg 2024; 16:3484-3498. [PMID: 39649202 PMCID: PMC11622100 DOI: 10.4240/wjgs.v16.i11.3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/27/2024] [Accepted: 09/10/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) delays the postoperative recovery of gastrointestinal function in patients with gastric cancer (GC), leading to longer hospitalization and higher healthcare expenditure. However, effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of the lack of noninvasive methods. AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice. METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021. Among them, PPOI was reported in 33 cases. The patients were randomly divided into the training and validation cohorts. Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model. RESULTS The analysis identified six potential variables associated with PPOI among the included participants. The incidence rate of PPOI was 27.5%. Age ≥ 70 years, cTNM stage (I and IV), preoperative hypoproteinemia, recovery time of bowel sounds (RTBS), number of bowel sounds (NBS), and frequency of bowel sounds (FBS) were independent risk factors for PPOI. The Bayesian model demonstrated good performance with internal validation: Training cohort [area under the curve (AUC) = 0.880, accuracy = 0.823, Brier score = 0.139] and validation cohort (AUC = 0.747, accuracy = 0.690, Brier score = 0.215). The model showed a good fit and calibration in the decision curve analysis, indicating a significant net benefit. CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age, cTNM stage, preoperative hypoproteinemia, and specific bowel sound-related indices (RTBS, NBS, and FBS). To facilitate early intervention and improve patient outcomes, clinicians should consider these factors, optimize preoperative nutritional status, and implement routine postoperative bowel sound monitoring. This study introduces an accessible machine learning model for predicting PPOI in patients with GC.
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Affiliation(s)
- Shuai Shi
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Cong Lu
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Liang Shan
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Liang Yan
- Institute of Navigation, Northwestern Polytechnical University, Xi’an 710072, Shaanxi Province, China
| | - Yong Liang
- Electronics and Information Engineering, Xi'an Polytechnic University, Xi’an 710048, Shaanxi Province, China
| | - Tao Feng
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Zun Chen
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Xin Chen
- Department of Medicine, Xi'an Jiao Tong University, Xi’an 710065, Shaanxi Province, China
| | - Xi Wu
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Si-Da Liu
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
| | - Xiang-Long Duan
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
- Department of Medicine, Xi'an Jiao Tong University, Xi’an 710065, Shaanxi Province, China
- Shaanxi Engineering Research Center of Medical Polymer Materials, Xi’an 710072, Shaanxi Province, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, Shaanxi Province, China
| | - Ze-Zheng Wang
- Second Department General Surgery, Shaanxi Provincial People's Hospital, Xi’an 710068, Shaanxi Province, China
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Piazza G, Labgaa I, Uldry E, Melloul E, Halkic N, Joliat GR. Delayed Return of Gastrointestinal Function after Partial Hepatectomy: A Single-Center Cross-Sectional Study. Dig Surg 2024; 42:9-16. [PMID: 39536735 PMCID: PMC11887990 DOI: 10.1159/000542028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 10/05/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH. METHODS This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression. RESULTS A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence. CONCLUSION Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF. INTRODUCTION Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH. METHODS This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression. RESULTS A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence. CONCLUSION Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.
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Affiliation(s)
- Giulia Piazza
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland,
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
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Kao TW, Lin J, Huang CJ, Huang YC, Tsai TJ. Electroacupuncture of ST36 and PC6 for postoperative gastrointestinal recovery: A systematic review and meta-analysis. J Tradit Complement Med 2024; 14:666-674. [PMID: 39850598 PMCID: PMC11752119 DOI: 10.1016/j.jtcme.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 01/25/2025] Open
Abstract
Objective This study was designed to determine the efficacy and safety of electroacupuncture (EA) at acupoints ST36 and/or PC6 for postoperative gastrointestinal (GI) recovery. Method Studies were retrieved from the PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang, and Airiti library databases from inception to January 23, 2024. Randomized controlled trials (RCTs) that evaluated the effect of EA at ST36 and/or PC6 on postoperative GI recovery were reviewed. Studies that involved acupoints other than the two or treatment modalities other than EA were excluded. Results Meta-analysis of 17 RCTs revealed that the time to first flatus (Mean difference (MD) = -5.06 h; 95% Confidence interval (CI), -7.12 to -3.01) and time to first defecation (MD = -12.29 h; 95% CI, -20.64 to -5.21) were significantly shorter in the EA group compared with the control group. The incidence of post-operative nausea and vomiting (PONV) was also significantly lower in the EA group than in the control group (Risk ratio (RR) = 0.62; 95% CI, 0.49-0.78). Conclusion EA application to ST36 or PC6 alone as an adjunctive therapy is effective and safe in promoting postoperative GI recovery and reducing PONV. The benefits are less obvious when ST36 and PC6 are combined. Acupoint selection and EA parameters are important factors that influence therapeutic effects. The establishment of a standardized EA protocol is imperative to minimize bias in research and to maximize applicability in clinical practice.
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Affiliation(s)
- Ting-Wan Kao
- Graduate Institute of Clinical Medicine, College of Medicine, Taiepi Medical University, Taiwan
| | - James Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Jen Huang
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chen Huang
- Research Center of big data and meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Ju Tsai
- Department of Chinese Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Bhatnagar A, Nigam N, Anne R, Santosh S. Pediatric Obesity's Effect on Open and Laparoscopic Appendectomy Outcomes. Surg J (N Y) 2024; 10:e37-e42. [PMID: 39628903 PMCID: PMC11502119 DOI: 10.1055/s-0044-1791968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/23/2024] [Indexed: 12/06/2024] Open
Abstract
Background Pediatric obesity is a common comorbid condition that may complicate pediatric surgeries, such as appendectomy. Prior research on the consequences of obesity on pediatric appendectomy outcomes have been limited by small-sample sizes and pooled analyses that do not distinguish the effects of surgical approach. Associations between surgical approach, pediatric obesity, and postoperative appendectomy outcomes thus remain unclear. Objective To analyze postoperative appendectomy outcomes by accounting for pediatric obesity, appendectomy approach, and their interaction. This is a retrospective cohort population analysis. Nationwide data of pediatric inpatients from the United States were obtained. All pediatric patients who had an appendectomy were selected from the 2019 Kids' Inpatient Database. Materials and Methods Outcomes variables were the length of stay and postoperative complication rate. The primary exposure variables were pediatric obesity, surgical approach (laparoscopic [LA] vs. open appendectomy [OA]), and an interaction term between the two. Control variables were patient demographics, clinical complexity, and geographic location. Multiple regression was used to determine relationships between the outcome, exposure, and control variables. Results A total of 49,037 pediatric patients had an appendectomy, with the number of OA and LA being 4,517 and 44,420, respectively. LA patients had 5.8% ( p < 0.001) shorter length of stay than OA patients. For obese patients, length of stay was 31.8% ( p < 0.001) longer than for nonobese patients, but LA (compared with OA) reduced it by 19% ( p < 0.007). Obesity had no effect on the number of postoperative complications. Conclusion Obese patients had significantly longer length of stay than nonobese counterparts following OA (31.8%), but this difference was minimized for LA patients (15.81%). There was no association between complication rate, obesity, and surgical approach. Our findings will enable more accurate estimations of pediatric patients' postoperative courses and efficient allocation of limited hospital resources. Further research may wish to study the effects of other common pediatric comorbidities on other procedures.
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Affiliation(s)
| | - Nishtha Nigam
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ
| | - Rohan Anne
- Department of Neuroscience, Lawrence University, Appleton, Wisconsin
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Marcin B, Katarzyna SA, Ivan K. The role of beta-adrenoreceptors in postoperative ileus in rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:4851-4857. [PMID: 38157026 PMCID: PMC11166813 DOI: 10.1007/s00210-023-02918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
The aim of the research was to evaluate the influence of antagonists of specific beta-adrenergic receptor subtypes on bowel motility following abdominal surgery in rat model of postoperative ileus. Bowel motility was measured by the intestinal transit of Evans blue introduced via orogastric tube after surgical procedures of skin incision, laparotomy and laparotomy with gut manipulation. Male rats were given individual adrenergic receptor subtypes antagonists intraperitoneally, and the influence of administered agents on intestinal transit of Evans blue was then evaluated. No statistically significant differences in the length of intestine in tested rats were observed. Propranolol administered prior to surgical procedure has shown protective effect on Evans blue migration in rats undergoing laparotomy and gut manipulation. Intestinal dye transit for propranolol doses of 10, 30 and 45 mg/kg was 18.00 ± 1.88c m, 23.75 ± 1.71 cm and 22.5 ± 2.43 cm, respectively, and for last two doses, statistically significant increase of dye passage was noted, compared to Evans blue transit of 11.00 ± 2.43 cm in the control group. No acceleration of dye migration was seen following administration of beta1-, beta2- and beta3-selective adrenergic receptor antagonist metoprolol, ICI 118.551 and SR58894A, respectively. Our research confirmed that propranolol at high doses, as seen by other researchers, improved bowel motility in early phase of postoperative ileus. That slight acceleration of intestinal dye transit after surgery with gut manipulation is rather connected with membrane-stabilizing action, than the receptor blocking effect, as this effect was not observed after the application of selective antagonists of respective subtypes of beta-adrenergic receptor.
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Affiliation(s)
- Bitel Marcin
- Department of Pharmacology, Faculty of Medicine, Medical University of Gdańsk, Dębowa Str. 23, 80-204, Gdańsk, Poland
| | | | - Kocić Ivan
- Department of Pharmacology, Faculty of Medicine, Medical University of Gdańsk, Dębowa Str. 23, 80-204, Gdańsk, Poland.
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Liu GXH, Milne T, Xu W, Varghese C, Keane C, O'Grady G, Bissett IP, Wells CI. Risk prediction algorithms for prolonged postoperative ileus: A systematic review. Colorectal Dis 2024; 26:1101-1113. [PMID: 38698504 DOI: 10.1111/codi.17010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/05/2024]
Abstract
AIM Prolonged postoperative ileus (PPOI) is common and is associated with a significant healthcare burden. Previous studies have attempted to predict PPOI clinically using risk prediction algorithms. The aim of this work was to systematically review and compare risk prediction algorithms for PPOI following colorectal surgery. METHOD A systematic literature search was conducted using MEDLINE, Embase, Web of Science and CINAHL Plus. Studies that developed and/or validated a risk prediction algorithm for PPOI in adults following colorectal surgery were included. Data were collected on study design, population and operative characteristics, the definition of PPOI used and risk prediction algorithm design and performance. Quality appraisal was assessed using the PROBAST tool. RESULTS Eleven studies with 87 549 participants were included in our review. Most were retrospective, single-centre analyses (6/11, 55%) and rates of PPOI varied from 10% to 28%. The most commonly used variables were sex (8/11, 73%), age (6/11, 55%) and surgical approach (5/11, 45%). Area under the curve ranged from 0.68-0.78, and only three models were validated. However, there was significant variation in the definition of PPOI used. No study reported sensitivity, specificity or positive/negative predictive values. CONCLUSION Currently available risk prediction algorithms for PPOI appear to discriminate moderately well, although there is a lack of validation data. Future studies should aim to use a standardized definition of PPOI, comprehensively report model performance and validate their findings using internal and external methodologies.
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Affiliation(s)
- Gordon Xin Hua Liu
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tony Milne
- Department of General Surgery, Auckland City Hospital, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Department of General Surgery, Middlemore Hospital, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - William Xu
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Whangarei Hospital, Te Whatu Ora Te Tai Tokerau, Northland, New Zealand
| | - Greg O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Auckland City Hospital, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Auckland City Hospital, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Auckland City Hospital, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
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10
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Song J, Zhou C, Zhang T. Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery: A meta-analysis. World J Gastrointest Surg 2024; 16:1420-1429. [PMID: 38817302 PMCID: PMC11135316 DOI: 10.4240/wjgs.v16.i5.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery. AIM To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients. METHODS Systematically searched the relevant literature from PubMed, Web of Science, Cochrane Library, Embase, CNKI, China Biomedical Database, Wanfang Database, and Weipu Chinese Journal Database self-established until October 1, 2022. Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature, extracted data, and evaluated the risk of bias in the included studies. RESULTS A total of 23 pieces of literature were included, the quality of which was medium or above, and the total sample size was 43878. The results of meta-analysis showed that the patients were male (OR = 1.58, 95%CI: 1.25-2.01, P = 0.002) and ≥ 60 years old (OR = 2.60, 95%CI: 1.76-2.87, P < 0.001), physical index ≥ 25.3 kg/m2 (OR = 1.6, 95%CI: 1.00-1. 12, P = 0.040), smoking history (OR = 1.89, 95%CI: 1.31-2.73, P < 0.001), chronic obstructive pulmonary disease (OR = 1.49, 95%CI: 1.22-1.83, P < 0.001), enterostomy (OR = 1.47, 95%CI: 1.26-1.70, P < 0.001), history of abdominal surgery (OR = 2.90, 95%CI: 1.67-5.03, P < 0.001), surgical site (OR = 1.2, 95%CI: 1.40-2.62, P < 0.001), operation method (OR = 1.68, 95%CI: 1.08-2.62, P = 0.020), operation duration (OR = 2.65, 95%CI: 1.92-3.67, P < 0.001), abdominal adhesion grade (OR = 2.52, 95%CI: 1.90-3.56, P < 0.001), postoperative opioid history (OR = 5.35, 95%CI: 3.29-8.71, P < 0.001), tumor TNM staging (OR = 2.58, 95%CI: 1.84-3.62, P < 0.001), postoperative blood transfusion (OR = 2.92, 95%CI: 0.88-9.73, P = 0.010) is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors. CONCLUSION There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients after surgery. Clinical staff should identify relevant risk factors early and implement targeted intervention measures on the basis of personalized assessment to improve the clinical prognosis of patients.
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Affiliation(s)
- Jia Song
- Department of Operating Room, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, Jiangsu Province, China
| | - Cong Zhou
- Department of Gastrointestinal Surgery, Tongji Hospital of Huazhong University of Science and Technology, Wuhan 430073, Hubei Province, China
| | - Tian Zhang
- Department of Disinfection Supply Center, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, Jiangsu Province, China
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11
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Yanagisawa T, Tatematsu N, Horiuchi M, Migitaka S, Yasuda S, Itatsu K, Kubota T, Sugiura H. Prolonged preoperative sedentary time is a risk factor for postoperative ileus in patients with colorectal cancer: a propensity score-matched retrospective study. Support Care Cancer 2023; 32:54. [PMID: 38129532 DOI: 10.1007/s00520-023-08271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This study aimed to investigate the association between prolonged preoperative sedentary time (ST) and postoperative ileus (POI) after adjusting for confounders in patients with colorectal cancer (CRC). METHODS This single-center retrospective study enrolled 155 consecutive patients who underwent surgery for primary CRC. A diagnosis of POI was made by the surgeons if the Clavien-Dindo classification (CD) grade is ≥ 2 within 30 days after surgery. Preoperative ST was assessed using the International Physical Activity Questionnaire usual week short version (Japanese version). Patients were classified into two groups (ST < 6 h/day and ST ≥ 6 h/day) based on results from the questionnaire, and data were analyzed using a propensity score-matching strategy to adjust for confounders. In addition, receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value of preoperative ST for predicting POI. RESULTS Of the 155 patients, 134 were included in the analysis. POI occurred in 16 (11.9%) patients of overall patients and 11 (12.5%) of the 88 matched patients. The logistic regression analysis after propensity score-matching showed that prolonged preoperative ST (ST ≥ 6 h/day) was associated with POI (odds ratio 5.40 (95% confidence interval: 1.09 - 26.60), p = 0.038). The ROC curve analysis indicated that the optimal cutoff value of preoperative ST for predicting POI was 6 h/day. CONCLUSION Prolonged preoperative ST is a risk factor for POI in patients with CRC. Therefore, reducing preoperative ST may play an important role in preventing POI.
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Affiliation(s)
- Takuya Yanagisawa
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan.
| | - Mioko Horiuchi
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Saki Migitaka
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Shotaro Yasuda
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Keita Itatsu
- Department of Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Tomoyuki Kubota
- Department of Breast Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-Kitamachi, Kita-Ku, Nagoya, Aichi, 462-0802, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan
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12
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Nakamura M, Tsuru I, Izumi T, Ono A, Inoue Y, Muraki Y, Yamada Y, Tsuji Y, Watanabe J, Fujimura M, Kihara S, Naito A, Shiratori T, Amakawa R, Inatsu H, Yoshimatsu T, Kashiwagi M, Fukuda A, Morikawa T, Kusakabe M, Suzuki M, Kameyama S, Kume H, Shiga Y. Advantages of enhanced recovery after surgery program in robot-assisted radical cystectomy. Sci Rep 2023; 13:16237. [PMID: 37758782 PMCID: PMC10533885 DOI: 10.1038/s41598-023-43489-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
Radical cystectomy is a gold-standard treatment for muscle-invasive bladder cancer. We recently introduced robot-assisted radical cystectomy (RARC) with perioperative enhanced recovery after surgery (ERAS). The medical records of patients with bladder cancer who underwent open radical cystectomy (ORC) or RARC/ERAS at NTT Medical Center Tokyo were retrospectively reviewed to compare the surgical outcomes, hospital stay, and medical costs between groups. Multidisciplinary full ERAS items were provided for the RARC/ERAS group. The median estimated blood losses in the ORC and RARC/ERAS groups were 650 and 100 mL, and the median operative times were 312 and 445 min, respectively. In addition, the median times to liquid food intake in these groups were 6 and 0 days, the median times to first flatus and first defecation were 2 and 1 day, and 3 and 1.5 days, respectively. The rates of postoperative ileus in the ORC and RARC/ERAS groups were 27.5% and 4.5%, and the median postoperative hospital stays was 26.5 and 12 days, respectively. Medical costs excluding surgery were significantly lower in the RARC/ERAS group. In conclusion, RARC/ERAS represents a safe treatment option for muscle-invasive bladder cancer with decreased perioperative complications and lower medical costs.
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Affiliation(s)
- Masaki Nakamura
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.
| | - Ibuki Tsuru
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Taro Izumi
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Akihiro Ono
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Yasushi Inoue
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Yasuko Muraki
- Information System Group, NTT Medical Center Tokyo, Tokyo, Japan
- Critical Pathway Committee, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yumi Yamada
- Critical Pathway Committee, NTT Medical Center Tokyo, Tokyo, Japan
- Nursing Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuko Tsuji
- Nutrition Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Junko Watanabe
- Department of Rehabilitation, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Shunsuke Kihara
- Operating Department, NTT Medical Center Tokyo, Tokyo, Japan
| | - Akihiro Naito
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Taichi Shiratori
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ryo Amakawa
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Hiroki Inatsu
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | - Tadashi Yoshimatsu
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
| | | | - Akira Fukuda
- Department of Rehabilitation, NTT Medical Center Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Motofumi Suzuki
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | | | - Haruki Kume
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiyuki Shiga
- Department of Urology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan
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13
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Zhao X, Si S, Liu X, Liu J, Zhang D, Mu Y, Hou A. Does invasive acupuncture improve postoperative ileus after colorectal cancer surgery? A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1201769. [PMID: 37692781 PMCID: PMC10485617 DOI: 10.3389/fmed.2023.1201769] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background Postoperative ileus (POI) is one of the main complications after colorectal cancer (CRC) surgery, and there is still a lack of effective treatment. At present, the evidence for improvement of POI by invasive acupuncture (manual acupuncture and electroacupuncture, IA) is limited. This meta-analysis of randomized controlled trials (RCTs) aims to systematically review and evaluate the effect of IA in improving POI after CRC surgery. Methods This meta-analysis was reported according to PRISMA statement and AMSTAR guidelines. The retrieval time was from the inception to February 2023. The RCTs were screened by searching the databases (PubMed, Ovid, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Database, Sinomed Database, and WANFANG). Two independent investigators screened and extracted the data, assessed the risk of bias, and performed statistical analysis. The statistical analysis was carried out by RevMan5.3. The PROSPERO International Prospective Register of Systematic Reviews received this research for registration (CRD42023387700). Results Thirteen studies with 795 patients were included. In the primary outcome indicators: the IA group had shorter time to the first flauts [stand mean difference (SMD), -0.57; 95% CI, -0.73 to -0.41, p < 0.00001], shorter time to the first defecation [mean difference (MD), -4.92 h, 95% CI -8.10 to -1.74 h, p = 0.002] than the blank/sham stimulation (B/S) group. In the secondary outcome indicators: the IA group had shorter time to the first bowel motion (MD, -6.62 h, 95% CI -8.73 to -4.50 h, p < 0.00001), shorter length of hospital (SMD, -0.40, 95% CI -0.60 to -0.21, p < 0.0001) than the B/S group. In terms of the subgroup analysis: IA associated with enhanced recovery after surgery (ERAS) group had shorter time to the first flauts (MD, -6.41 h, 95% CI -9.34 to -3.49 h, p < 0.0001), shorter time to the first defacation (MD, -6.02 h, 95% CI -9.28 to -2.77 h, p = 0.0003) than ERAS group. Conclusion Invasive acupuncture (IA) after CRC surgery, acupuncture or electricacupuncture with a fixed number of times and duration at therapeutic acupoints, can promote the recovery of POI. IA combined with ERAS is better than simple ERAS in improving POI. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=387700, identifier CRD42023387700.
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Affiliation(s)
- Xiaohu Zhao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shangkun Si
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xin Liu
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jingxuan Liu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongbin Zhang
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuejun Mu
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Aihua Hou
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
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14
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Fujimoto T, Manabe T, Yukimoto K, Tsuru Y, Kitagawa H, Okuyama K, Takesue S, Kai K, Noshiro H. Risk Factors for Postoperative Paralytic Ileus in Advanced-age Patients after Laparoscopic Colorectal Surgery: A Retrospective Study of 124 Consecutive Patients. J Anus Rectum Colon 2023; 7:30-37. [PMID: 36743464 PMCID: PMC9876602 DOI: 10.23922/jarc.2022-044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/09/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives Postoperative paralytic ileus (POI) is one of the most common and troublesome complications following colorectal surgery. However, to date, the risk factors for POI remain unclear. This study aimed to identify the risk factors for POI following laparoscopic colorectal surgery in advanced-age patients. Methods The clinical data of 124 patients aged ≥75 years who underwent curative colorectal surgery from January 2018 to December 2020 were retrospectively reviewed. The relationship between POI and clinicopathological data including sarcopenia and visceral fat obesity was then assessed. Sarcopenia was defined as a low skeletal muscle mass index; visceral obesity, visceral fat with an area ≥100 cm2 on computed tomography at the level of the third lumbar vertebra; and sarcobesity, sarcopenia with visceral obesity. Results The rate of POI was 9% (12/124 patients), and all the affected patients improved with conservative treatment. In the univariate and multivariate analyses, sarcopenia and sarcobesity were significant predictive factors for POI. Conclusions Sarcopenia and sarcobesity may be risk factors for POI in patients aged ≥75 years after laparoscopic colorectal surgery.
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Affiliation(s)
- Takaaki Fujimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Tatsuya Manabe
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Kumpei Yukimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Yasuhiro Tsuru
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Hiroshi Kitagawa
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keiichiro Okuyama
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Shin Takesue
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Nabeshima, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
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15
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Yang X, Tian C, Gao Y, Yang L, Wu Y, Zhang N. Effect of remote ischemic preconditioning in patients undergoing laparoscopic colorectal cancer surgery: a randomized controlled trial. Scand J Gastroenterol 2022; 58:634-642. [PMID: 36469647 DOI: 10.1080/00365521.2022.2153344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) is reported to reduce ischemia-reperfusion injury (IRI) in many vital organs by inhibiting a systemic inflammatory response. Inflammation also plays an essential role in the pathophysiology of prolonged post-operative ileus (PPOI) in patients undergoing colorectal cancer (CRC) surgery. However, the role of RIPC is unclear in reducing the incidence of PPOI in patients undergoing CRC surgery. METHODS This was a prospective, randomized trial of RIPC vs. placebo-controlled in patients undergoing elective laparoscopic CRC surgery. Eighty patients were randomized to either a RIPC group or a control group (40 per arm), with computer-generated randomization. The aim was to determine whether RIPC improved the recovery of gut function. The primary outcomes assessed were time to gastrointestinal tolerance and incidence of PPOI. RESULTS Median time to stool of the RIPC group was significantly lower than that of the control group [RIPC vs. control, 4.0 (3.0, 6.0) vs. 5.0 (4.0, 7.8) days, p = 0.027]. Median time to gastrointestinal tolerance and incidence of PPOI in the RIPC group were lower than the control group; however, there were no statistical differences between the two groups [RIPC vs. control: 5.0 (3.0, 7.0) vs. 6.0 (4.0, 8.8) days, p = 0.178; 15 vs. 30%, p = 0.108]. CONCLUSION RIPC could shorten the median time to stool in patients undergoing laparoscopic CRC surgery, but did not improve the overall recovery time of gut function or reduce the incidence of PPOI. REGISTRATION NUMBER ChiCTR2100043313 (http://www.chictr.org.cn).Key pointsQuestion: In patients undergoing laparoscopic CRC surgery, does RIPC improve time to the overall recovery of gut function and reduce the incidence of PPOI?Findings: In this randomized clinical trial that included 80 patients undergoing elective laparoscopic CRC surgery, no significant difference was found between the RIPC group and the control group concerning median time to gastrointestinal tolerance and incidence of PPOI.Meaning: RIPC did not improve the time for overall recovery of gut function or reduce the incidence of PPOI in patients undergoing laparoscopic CRC surgery.
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Affiliation(s)
- Xiuming Yang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Tian
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yuansong Gao
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Yang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - You Wu
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zhang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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16
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Booth A, Leo MD, Kovacs M, Maxwell PJ, Donahue C, George VV, Curran T. Preoperative small bowel dilation is associated with ileus after right colectomy. SURGERY IN PRACTICE AND SCIENCE 2022; 10:100109. [PMID: 39845598 PMCID: PMC11749979 DOI: 10.1016/j.sipas.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background The relationship between preoperative bowel dysfunction and postoperative ileus has not been explored clinically. We hypothesized chronic partial obstruction, based on preoperative small bowel diameter, is associated with ileus after colon surgery. Methods This was a retrospective case-control study of patients undergoing right colectomy or ileocolic resection with primary anastomosis. Patients who developed ileus were compared to those who did not. Results Postoperative ileus occurred in 22 of 69 patients (32%). Preoperative small bowel dilation with maximum diameter >3 cm was present in 13 patients (19%) with 7 developing ileus (54%; p=0.06). In a multivariable model, small bowel dilation >3 cm (OR 4.6; 95% CI: 1.3-16.6) and preoperative weight loss >10 pounds (OR 9.8; 95% CI: 1.6-57.9) were independently associated with ileus. Conclusions Colorectal surgery patients with preoperative bowel dilation have an increased risk of postoperative ileus. This knowledge can better inform patient expectations for recovery and help guide perioperative nutritional management, particularly with patient selection for parenteral nutrition.
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Affiliation(s)
- Alexander Booth
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Matthew Di Leo
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Mark Kovacs
- Department of Radiology, Medical University of South Carolina, Charleston, SC, United States
| | - Pinckney Johnstone Maxwell
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Colleen Donahue
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Virgilio V George
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Thomas Curran
- Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
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17
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Zhang J, Bao Y. Value of MSCT plus MRI in the Detection of Colon Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6507865. [PMID: 35685721 PMCID: PMC9173996 DOI: 10.1155/2022/6507865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Colon cancer is a common digestive system malignancy with nonspecific early symptoms, which necessitates better early detection methods. The present study was conducted to assess the accuracy and clinical value of multislice spiral CT (MSCT) plus magnetic resonance imaging (MRI) for colon cancer. Between January 2019 and July 2020, 100 patients with pathologically confirmed colon cancer treated in Wuxi People's Hospital were assessed for eligibility and recruited. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT were analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was obtained to analyze the preoperative diagnostic value. The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100% with good consistency (Kappa = 0.732, 0.703, and 0.756). The AUC of MRI, MSCT, and MRI plus MSCT was 0.889, 0.861, and 0.903, respectively. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92%, 82.61%, 73.47%, and 86.67%, respectively, those of MSCT was 53.85%, 69.57%, 63.27%, and 40.00%, respectively, and those of MRI plus MSCT was 100.00%, 95.65%, 95.92%, and 86.67%, respectively. Consistency analysis yielded good consistency for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, 0.776). MSCT plus MRI yielded higher accuracy, specificity, and sensitivity in the detection of colon cancer versus the standalone MRI or MSCT, which demonstrated great potential in the early detection of colon cancer with a high clinical value.
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Affiliation(s)
- Jingni Zhang
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu Province, China
| | - Yu Bao
- Medical Imaging Center, Wuxi People's Hospital, Wuxi 214043, Jiangsu Province, China
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A nomogram to predict prolonged postoperative ileus after intestinal resection for Crohn's disease. Int J Colorectal Dis 2022; 37:949-956. [PMID: 35315507 DOI: 10.1007/s00384-022-04134-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE We aim to identify the risk factors of PPOI in patients with CD and create a nomogram for prediction of PPOI for CD. METHODS Data on 462 patients who underwent partial intestinal resection for CD in Jin-ling Hospital between January 2019 and June 2021 were retrospectively collected. Univariate and multivariate analyses were performed to determine the risk factors for PPOI and we used the risk factors to create a nomogram. Then we used the Bootstrap-Concordance index and calibration diagrams to evaluate the performance of the Nomogram. Decision curve analysis was performed to evaluate clinical practicability of the model. RESULTS The incidence of PPOI was 27.7% (n of N). Course of CD ≥ 10 years, operation time ≥ 154 min, the lowest mean arterial pressure ≤ 76.2 mmHg, in-out balance per body weight ≥ 22.90 ml/kg, post-op day 1 infusion ≥ 2847 ml, post-op lowest K+ ≤ 3.75 mmol/L, and post-op day 1 procalcitonin ≥ 2.445 ng/ml were identified as the independent risk factors of PPOI in patients with CD. The nomogram we created by these risk factors presented with good discriminative ability (concordance index 0.723) and was moderately calibrated (bootstrapped concordance index 0.704). The results of decision curve analysis showed that the nomogram was clinically effective within probability thresholds in the 8 to 66% range. CONCLUSION The nomogram we developed is helpful to evaluate the risk of developing PPOI after partial intestinal resection for CD. Clinicians can take more necessary measures to prevent PPOI in CD's patients or at least minimize the incidence.
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