Abstract
Postoperative gastrointestinal tract (GIT) dysfunction (POGD) and postoperative ileus (POI) are common symptoms resulting from small or large bowel surgery associated with extended hospitalizations, increase risk of infections and billions of dollars in health care costs. Open surgery is associated with higher gut surgical trauma / manipulation and worse outcomes compared to minimal invasive surgery. Robotic Surgery may offer added benefit to Colon Enhanced Recovery After Surgery (CERAS) protocols but do not solve the problem. Ultimately, a better understanding of the pathogenic mechanisms of POI and POGD can lead to prophylaxis and enhanced recovery after surgery. The impact of High Pressure Pneumoperitoneum and gut surgical manipulation on GIT dysfunction deserve further investigation.
Highlights
Postoperative ileus (POI) and Postoperative gastrointestinal dysfunction (POGD) are well-documented complications after abdominal surgery
The incidence of POI and POGD are unclear and reports range from 3% to 32% and it is higher after open surgery due to more considerable surgical trauma, gut manipulation, extended surgical time, ischemia and inflammation [1,2,3]
Despite lower incidence of POI with a minimal invasive approach compared with open surgery [2,27] and improvements seen with implementation of Colon Enhanced Recovery After Surgery (CERAS) protocols, this technique requires carbon dioxide (C02) and higher abdominal pressure in order to enhance laparoscopic visualization for surgery
Summary
Postoperative ileus (POI) and Postoperative gastrointestinal dysfunction (POGD) are well-documented complications after abdominal surgery. The incidence of POI and POGD are unclear and reports range from 3% to 32% and it is higher after open surgery due to more considerable surgical trauma, gut manipulation, extended surgical time, ischemia and inflammation [1,2,3]. It is not surprising that open surgery is associated with more inflammation and extended periods of POI than minimally invasive laparoscopic surgery [5,6].
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