Published online Feb 27, 2018. doi: 10.4240/wjgs.v10.i2.13
Peer-review started: November 15, 2017
First decision: December 8, 2017
Revised: December 9, 2017
Accepted: February 5, 2018
Article in press: February 6, 2018
Published online: February 27, 2018
Processing time: 104 Days and 0.5 Hours
Postoperative ileus (POI) after gastrectomy is not rare and causes various symptoms, which probably affects patient recovery, prolongs hospital stay, and increases cost. However, there is no effective way to alleviate POI until now.
Transcutaneous electroacupuncture (TEA) is a new-developed, non-invasive and portable device. It has been validated to improve intestinal dysmotility in dog experiment. But it remains unknown whether it is useful to alleviate POI for post-gastrectomy patients clinically.
The aim of this article was investigating the efficacy and safety of TEA to alleviate POI after gastrectomy.
From April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA (n = 33) or control (n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan (ST36) and Zusanli (PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.
Time to first flatus in the TEA group was significantly shorter than in the control group (73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy (76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group (2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group (4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet (5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group (8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There were no severe adverse events related to TEA.
In this prospective and randomized clinical study, we confirmed the role of TEA in the treatment of post-gastrectomy bowel motility recovery for the first time. TEA in gastric cancer patients significantly increased postoperative bowel movement; shortened time to first flatus, nasogastric tube removal, liquid diet and hospital stay, and it was safe.
The authors proved that TEA was effective and safe to recovery post-gastrectomy patients from POI. So it will probably provide clinical surgeons with a novel non-invasive device to accelerate bowel function recovery and reduce hospital stay, which satisfies the concept of enhanced recovery after surgery (ERAS). Besides, TEA could be considered to be applied on other abdominal surgeries as well.