Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative.

Abstract

Postoperative ileus usually lasts for 2-5 days after colonic surgery and may contribute to discomfort and pulmonary complications. With multimodal rehabilitation (epidural analgesia, early oral nutrition and mobilization, and laxative) defaecation occurs 1-2 days after colonic surgery. The aim of this study was to assess the transit rate of the entire gastrointestinal tract after colonic resection with multimodal rehabilitation. Gastrointestinal motility was assessed by means of a scintigraphic method in 12 patients undergoing open colonic resection with multimodal rehabilitation and in 12 matched healthy volunteers. After intragastric or oral administration of 4 MBq 111In-labelled diethylenetriamine penta-acetic acid, images of the abdomen were taken at 24 and 48 h with a double-headed gamma camera. Patient and volunteer demographics were similar. The first defaecation occurred a median of 1 day after operation in the patients. Some 57 per cent of the tracer was excreted in faeces of patients and 53 per cent in faeces of volunteers (P > 0.05) within 48 h, indicating rapid recovery of the entire gastrointestinal motility after colonic resection with multimodal rehabilitation. This study documents early normalization of the entire gastrointestinal motility assessed by an 111In scintigraphic method in patients undergoing open colonic resection with a multimodal rehabilitation programme.