Earlier Recovery Of Bowel Function Research Articles

Effect of chewing gum in reducing postoperative ileus after gastroduodenal perforation peritonitis surgery: A prospective randomised controlled trial.

Chewing gum reduces the duration of postoperative ileus and early recovery of bowel function following elective abdominal surgery. However, its role has not been studied in cases of gastroduodenal perforation peritonitis, prompting us to conduct this study. Patients were randomised into two groups, 39 patients received chewing gum (study group) and 43 patients were in the control group. Sensation of hunger, appearance of first bowel sound, and passages of flatus and faeces were significantly early in the study group; their hospital stay was also shorter. Chewing gum reduces the duration of postoperative ileus in cases of gastroduodenal perforation peritonitis.Registration number: IEC/2020-23/3359 dated 13 December 2020, Institutional Ethics Committee, Netaji Subhash Chandra Bose Medical College, Jabalpur, India.

Opioid-Free Anesthesia for Open Radical Cystectomy Is Feasible and Accelerates Return of Bowel Function: A Matched Cohort Study.

The aim of this study was to evaluate the feasibility of opioid-free anesthesia (OFA) in open radical cystectomy (ORC) with urinary diversion and to assess the impact on recovery of gastrointestinal function. We hypothesized that OFA would lead to earlier recovery of bowel function. A total of 44 patients who underwent standardized ORC were divided into two groups (OFA group vs. control group). In both groups, patients received epidural analgesia (OFA group: bupivacaine 0.25%, control group: bupivacaine 0.1%, fentanyl 2 mcg/mL, and epinephrine 2 mcg/mL). The primary endpoint was time to first defecation. Secondary endpoints were incidence of postoperative ileus (POI) and incidence of postoperative nausea and vomiting (PONV). The median time to first defecation was 62.5 h [45.8-80.8] in the OFA group and 118.5 h [82.6-142.3] (p < 0.001) in the control group. With regard to POI (OFA group: 1/22 patients (4.5%); control group: 2/22 (9.1%)) and PONV (OFA group: 5/22 patients (22.7%); control group: 10/22 (45.5%)), trends but no significant results were found (p = 0.99 and p = 0.203, respectively). OFA appears to be feasible in ORC and to improve postoperative functional gastrointestinal recovery by halving the time to first defecation compared with standard fentanyl-based intraoperative anesthesia.

Effect of preoperative predigested formula vs. polymeric formula on bowel function recovery after definitive surgery for small intestinal entero-atmospheric fistula in patients with chyme reinfusion.

The purpose of this study is to compare the effect of preoperative predigested formula vs. polymeric formula on bowel function recovery following definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF). In this retrospective study, from January 2005 to December 2019, the patients with small intestinal EAF and receiving a DS were enrolled. During the preoperative treatment, each patient received enteral nutrition via nasojejunal feeding and chyme reinfusion. The enrolled subjects were classified into two groups, based on their formula type: polymeric formula and predigested formula. Then, propensity scores matching (PSM) was used to further divide these patients into PSM polymeric formula group or PSM predigested formula group. The clinical characteristics of the groups were analyzed. A total of 137 patients were finally enrolled, with 72 patients in the polymeric formula group and 65 patients in predigested formula group. The postoperative ileus was manifested in a total of 61 (44.5%) cases, with 27 (37.5%) in the polymeric formula group and 34 (52.3%) in the predigested formula group (P = 0.04). It was predicted that the polymeric formula could result in a reduction in postoperative ileus (OR = 0.47; 95% CI: 0.21-0.95; P = 0.04). After 1:1 PSM, there were 110 patients included. The postoperative ileus was observed in 47 patients, with 18 (32.7%) in the polymeric formula group and 29 (52.7%) in the predigested formula group (P = 0.03). After PSM, the polymeric formula demonstrated a reduction in the incidence of postoperative ileus (OR = 0.42; 95% CI: 0.19-0.92; P = 0.03). Compared with predigested formula, the preoperative polymeric formula appears to be associated with earlier recovery of bowel function after DS for EAF.

Comparison of enhanced recovery protocol with conventional care in patients undergoing urogynecological surgery.

The impact of enhanced recovery after surgery (ERAS) protocol on postoperative outcomes after urogynecological surgery is yet to be a matter of investigation. This study sought to evaluate this issue by comparing the patients who had conventional or ERAS--guided perioperative care for several clinical end-points including ambulation, length of hospital stay (LOS), readmissions, and postoperative complications. A total of 121 patients undergoing pelvic organ prolapse surgery were allocated to two study arms, ERAS protocol (Group E) or conventional care (Group C). Variables reflecting the restoration of appetite and bowel movements, bleeding events, other complications, LOS and readmissions were compared between the groups. The patients in Group C significantly received a more intensive intravenous fluid treatment compared to Group E (2,760 ± 656 vs. 1,045 ± 218 mL, P < 0.001). Time required for first flatus, first defecation, eating solid food, and ambulation (P < 0.001) were also longer in the former group of patients. Moreover, LOS was significantly reduced when the ERAS protocol was applied (2.5 ± 1.1 vs. 2.0 ± 0.6 days, P < 0.001). On the other hand, the two groups were similar with respect to the frequency of the postoperative complications, including surgical site infections, cardiovascular complications, non-specific abdominal pain, sub-ileus, blood loss and readmission rate. In our sample population, ERAS protocol led to early initiation of oral intake, early recovery of bowel function, early mobilization, and early discharge of patients without compromise in safety concerns after urogynecological surgery.

Effects of Reversal Technique for Neuromuscular Paralysis on Time to Recovery of Bowel Function after Craniotomy.

Non-depolarizing neuromuscular blockade can be reversed with neostigmine/glycopyrrolate or sugammadex. We test the hypothesis that sugammadex is associated with earlier postoperative recovery of bowel function (first bowel movement, BM). In adult patients undergoing craniotomy from 2016 to 2019, we identified time of first postoperative BM after receiving neostigmine/glycopyrrolate or sugammadex to reverse neuromuscular blockade. Logistic and proportional hazard regression, with and without inverse probability of treatment weighting (IPTW), were used to assess whether sugammadex is associated with earlier recovery of bowel function. Seven hundred and thirty-one patients underwent craniotomy, 323 (44.2%) received neostigmine/glycopyrrolate, and 408 (55.8%) sugammadex. From logistic regression analysis, the proportion of patients having a BM within the first 24 and 48 hours was higher in sugammadex group (unadjusted OR [95% CI]) 1.79 [1.16 to 2.77] P = .009; and 1.45 [1.08 to 1.94] P = .014; IPTW adjusted OR [95% CI]) 1.58 [.95, 2.61] P = .078; and 1.38 [.95 to 2.02] P = .095 for 24 and 48h, respectively). From proportional hazards regression, sugammadex was associated with improved bowel function recovery (unadjusted hazard ratio (HR) [95% CI] 1.35 [1.08, 1.68], P = .008; IPTW adjusted HR 1.29 [.97 to 1.71], P = .076). Patients undergoing craniotomy who had neuromuscular blockade reversed with sugammadex may have earlier recovered bowel function compared to patients reversed with neostigmine/glycopyrrolate.

Extraperitoneal Single-Port Robot-Assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy (RARP) is currently the standard minimally invasive procedure for the surgical management of localized prostate cancer. It has been shown that the minimally invasive robotic approach offers comparable oncologic and functional outcomes with potential advantages, including decreased blood loss, shorter hospital stay, and recovery period when compared with open surgery. Generally, the transperitoneal RARP approach is the most commonly performed among robotic surgeons, owing to its wider space and early adoption. However, similar oncologic outcomes have been reported with the extraperitoneal approach. Owing to its perceived technical difficulty, extraperitoneal RARP is less adopted nowadays. This approach, however, has its merits particularly in cases where intraperitoneal access can be problematic with extensive adhesions from previous surgeries. Also, extraperitoneal approach allows for minimal bowel manipulation, less steep Trendelenburg positioning, and less pneumoperitoneum, which reflect on early recovery of bowel function after RARP. Both transperitoneal and extraperitoneal approaches can be performed using either the conventional multiport robotic system or the more recent single-port (SP) robotic system. With respect to extraperitoneal RARP, there has been an increased adoption of the SP system, with purported advantages such as better cosmesis, less postoperative analgesic and opioid requirements, and shorter duration of hospital stay. Herein, we describe the technical steps relevant to extraperitoneal single-port robot-assisted radical prostatectomy, and elaborate on the clinical outcomes reported in the literature.

Epidural Anesthesia in Liver Surgery-A Propensity Score-Matched Analysis.

To assess the effects of epidural anesthesia (EA) on patients who underwent liver resection. Secondary analysis of a prospective randomized controlled trial. This single-center study was conducted at an academic medical center. A subset of 110 1:1 propensity score-matched patients who underwent liver resection with and without EA were analyzed. Outcome measures were pain intensity ≥5 on a numeric rating scale (NRS) at rest and during movement on postoperative days 1-5, analyzed with logistic mixed-effects models, and postoperative complications according to the Clavien-Dindo classification, length of hospital stay (LOS), and one-year survival. One-year survival in the matched cohorts was compared using a frailty model. EA patients were less likely to experience NRS ≥5 at rest (odds ratio = 0.06, 95% confidence interval [CI] = 0.01 to 0.28, P < 0.001). These findings were independent of age, sex, Charlson comorbidity index, baseline NRS, and surgical approach (open vs laparoscopic). The number and severity of postoperative complications and LOS were comparable between groups (P = 0.258, P > 0.999, and P = 0.467, respectively). Reduced mortality rates were seen in the EA group one year after surgery (9.1% vs 30.9%, hazard ratio = 0.32, 95% CI = 0.11 to 0.90, P = 0.031). No EA-related adverse events occurred. Earlier recovery of bowel function was seen in EA patients. Patients with EA had better postoperative pain control and required fewer systemic opioids. Postoperative complications and LOS did not differ, although one-year survival was significantly improved in patients with EA. EA applied in liver surgery was effective and safe.

The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer

BackgroundTo evaluate the feasibility and safety of a new surgical method, complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer.MethodsWe retrospectively analyzed and compared the data of consecutive patients with right-transverse colon cancer who underwent complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction (n = 23) and conventional complete laparoscopic extended right hemicolectomy (n = 34) in our hospital between October 2017 to May 2019, respectively.ResultsThe overall operation time of the ileocecal junction-preserved group was significantly shorter than that of the control group (p = 0.048). There was no difference in the number of harvested lymph nodes, metastatic lymph nodes, and rate of metastatic lymph nodes (p > 0.05). The ileocecal junction-preserved group showed shorter time of first flatus, lower frequency of postoperative diarrhea, and shorter duration of postoperative hospitalization. Furthermore, it also showed that the defecation frequency was lower in the ileocecal junction-preserved group than the control group on the 1st, 3rd, and 6th month (p < 0.05), and the number of patients who defecated at night or defecated four times or more a day was less in the ileocecal junction-preserved group than control group on the 1st month (p < 0.05).ConclusionThe complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction promises as a safe and feasible surgical procedure for right-transverse colon cancer, associated with earlier recovery of bowel function, shorter operation time, and similar pathological outcomes when compared to the conventional laparoscopic procedure.

A precise temperature control during hyperthermic intraperitoneal chemotherapy promises an early return of bowel function

ABSTRACT Introduction The hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely applied in clinical practice for peritoneal carcinomatosis (PC). The temperature is one of the important elements affecting the efficacy of HIPEC, and it can become fluctuant by several factors. This study is aimed to explore the role of a stable perfusion temperature in promoting bowel recovery of PC patients due to gastrointestinal malignancies. Methods Between January 2012 and July 2013, 59 PC patients undergoing cytoreductive surgery and three-cycle HIPEC were included. Patients having stable perfusion temperature for all cycles were assigned into the study group, with the rest having unstable temperature into the control group. Time of flatus and defecation passage and initiation time of enteral nutrition were compared between both groups to detect the significance in bowel function recovery, with visual analogue scale (VAS) pain intensity and overall survival (OS) compared meanwhile. Results In sum, 33 (55.9%) patients obtained stable temperature during HIPEC, and the rest of 26 (44.1%) developed fluctuant perfusion temperature. Average time of flatus (2.3 ± 1.2 vs 3.9 ± 2.2 days, P =.002), defecation passage (5.2 ± 2.1 vs 7.1 ± 2.9 days, P =.004) and enteral nutrition initiation (4.3 ± 1.5 vs 6.7 ± 2.3 days, P <.001) were much shorter in the study group than the control group. Additionally, the VAS score (4.5 ± 2.3 vs 6.3 ± 1.3, P <.001) and 5-year OS rate (17.8% vs 11.1%, P=.135) were both improved, with significance observed in postoperative pain control. Conclusions During HIPEC, a precise temperature control could promise an early recovery of bowel function and reduce postoperative pain, without survival significance found based on the current cohort.

Attenuation of Pneumoperitoneum-Induced Hypertension by Intraoperative Lidocaine Infusion in Laparoscopic Cholecystectomy

Background: Laparoscopy has now become the standard technique and is considered gold standard for cholecystectomy but the intraoperative requirements of laparoscopic surgery produce significant physiological changes, which pose many challenges for the anesthesiologist. Objective: The aim of this work was to evaluate the effect of intraoperative IV lidocaine infusion for attenuation of pneumoperitoneum-induced hypertension. Patients and Methods: After approval of the Medical Ethical Committee at Al-Azhar University Hospitals, Department of Anesthesia, and after patient written consent, 90 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for laparoscopic cholecystectomy were enrolled in this randomized, controlled, prospective, double-blind, clinical trial study. Results: Regarding the intraoperative and postoperative hemodynamics, in the present study it was observed that patients who received intravenous lidocaine (1.5 mg/kg bolus before skin incision and abdominal inflation followed by 1 mg/kg/h or 2 mg/kg/h and stopped immediately after abdominal deflation) were associated with a reduction in intraoperative BP and HR without any associated hemodynamic instability in comparison to patients who did not received lidocaine with no statistically significant difference between the two doses of lidocaine. Conclusion: This study showed that the intraoperative infusion of lidocaine of two different doses in patients undergoing laparoscopic cholecystectomy was associated with attenuation of blood pressure, heart rate, decreases the intensity of postoperative pain, and early recovery of bowel function without causing significant adverse effects, with more satisfaction for both patients and surgeons.

Attenuation of Pneumoperitoneum-Induced Hypertension by Intraoperative Lidocaine Infusion in Laparoscopic Cholecystectomy

Background: Laparoscopy has now become the standard technique and is considered gold standard for cholecystectomy but the intraoperative requirements of laparoscopic surgery produce significant physiological changes, which pose many challenges for the anesthesiologist. Objective: The aim of this work was to evaluate the effect of intraoperative IV lidocaine infusion for attenuation of pneumoperitoneum-induced hypertension. Patients and Methods: After approval of the Medical Ethical Committee at Al-Azhar University Hospitals, Department of Anesthesia, and after patient written consent, 90 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for laparoscopic cholecystectomy were enrolled in this randomized, controlled, prospective, double-blind, clinical trial study. Results: Regarding the intraoperative and postoperative hemodynamics, in the present study it was observed that patients who received intravenous lidocaine (1.5 mg/kg bolus before skin incision and abdominal inflation followed by 1 mg/kg/h or 2 mg/kg/h and stopped immediately after abdominal deflation) were associated with a reduction in intraoperative BP and HR without any associated hemodynamic instability in comparison to patients who did not received lidocaine with no statistically significant difference between the two doses of lidocaine. Conclusion: This study showed that the intraoperative infusion of lidocaine of two different doses in patients undergoing laparoscopic cholecystectomy was associated with attenuation of blood pressure, heart rate, decreases the intensity of postoperative pain, and early recovery of bowel function without causing significant adverse effects, with more satisfaction for both patients and surgeons.

Evaluation of The Feasibility and Safety of Laparoscopic Rectal Resection for Rectal Carcinoma After Neoadjuvant Chemoradiation

Purpose: This study aimed to evaluate the technical feasibility and oncological safety of laparoscopic total mesorectal excision (TME) for rectal carcinoma after chemoradiotherapy. Methods: 30 Patients with T3, T4 and⁄ or N1-2 rectal cancer were subjected to a preoperative neoadjuvant chemoradiotherapy (nCRT) protocol in the form of 45-50 Gy of external irradiation over 25-28 weekly fractions to the true pelvis concomitant with oral Capecitabine 825 mg/m2 twice daily. Results: This study included 16 males (53.3%) and 14 females (46.7%) with a mean age of 48.63 ±12.53 years. 19 patients (63.3%) underwent laparoscopic low anterior resection (LLAR) while 11 patients (36.7%) underwent laparoscopic abdominoperineal resection (LAPR). Mean blood loss was 66.05 ± 31.60 cc in LAR group and 241.82 ± 101.37 cc in APR group, the operative time was longer in APR group. The intra-operative adverse events occurred in 7 patients (23.3%). Earlier recovery of bowel function was observed in both groups; with shorter postoperative hospital stay in LLAR vs LAPR groups. Involvement of the circumferential resection margin occurred in two cases (6.7%), the mean number of harvested lymph nodes was 10.57±1.74 lymph node, the distal and proximal resection margins were free from malignant infiltration in all cases. Postoperative morbidity occurred in 8 patients (26.7%) with one case of local recurrence (3.3%). Conclusions: Based on the controllable surgical complications, minimal invasiveness and achieved oncological safety in the current patient series, laparoscopic TME is shown to be technically feasible and oncologically safe and can be recommended for patients with rectal carcinoma requiring preoperative chemoradiotherapy.

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Background/Aims: To compare short- and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in obese (body mass index >30 kg/m²) patients. Patients and Methods: Sixty-four consecutive obese patients who underwent laparoscopic (LPS) right colectomy with IA were matched with 64 patients who underwent LPS right colectomy with EA. Intraoperative variables, short-term outcomes, readmission rates, and morbidity and mortality rates were analyzed along with long-term outcomes. Results: Conversion to open surgery occurred in 4 patients in the IA group and 11 patients in the EA group (p = 0.097). The overall 30-day morbidity rate was 29.6% in the IA and 32.8% in the EA (p = 0.70). No 30-day mortality occurred. Anastomotic leak occurred in 4.7% of patients in the IA group vs. 7.8% in the EA group (p = 0.71). In the IA group, an earlier recovery of bowel function was observed (p = 0.01). No differences were observed with respect to the length of stay and reoperation rate. No 30-day readmission occurred in the IA compared to 5 patients readmitted in the EA group (p = 0.058). A higher incidence of incisional hernia was observed in the EA group (p = 0.033). Conclusion: IA in obese patients is associated with similar short-term outcomes, lower incidence of incisional hernias, and might possibly reduce the risk of hospital readmission.

Acupuncture for enhancing early recovery of bowel function in cancer

Cancer patients undergoing surgical procedure often suffer from bowel dysfunction and postoperative ileus (POI). Cancer management for early recovery of bowel function is still a challenging topic. Acupuncture has been commonly used in a variety of gastrointestinal diseases. The aim of this study is to evaluate the effects of acupuncture therapy to reduce the duration of POI and enhance bowel function in cancer patients. We will systematically screen all randomized controlled trials (RCTs) published through electronically and hand searching. The following search engines including Medline, EMBASE, Cochrane CENTRAL, the Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, VIP Information, Wanfang Data, one Japanese database (Japan Science and Technology Information Aggregator, Electronic) and 2 Korean Medical Databases (Korean Studies Information, and Data Base Periodical Information Academic) will be retrieved. Supplementary sources will be searched including gray literature, conference proceedings, and potential identified publications. Two reviewers will independently conduct the trial inclusion, data extraction and assess the quality of studies. The time to first passing flatus and time to first bowel motion will be assessed as the primary outcomes. Adverse effects, time to first bowel sound, visual analog scale (VAS) pain score, hospital stay, and postoperative analgesic requirement will be measured as secondary outcomes. Methodological quality will be evaluated according to the Cochrane risk of bias. Details of interventions will be assessed by the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. All analyses will be applied by RevMan (version 5.3) and StataSE (version 12). This systematic review will provide up-to-date information on acupuncture therapy for early recovery of bowel function in cancer patients. This review does not require ethical approval and will be reported in a peer-reviewed journal and presented at a relevant conference. PROSPERO CRD42016049633.

Effectiveness of Acupuncture for Early Recovery of Bowel Function in Cancer: A Systematic Review and Meta-Analysis.

Objectives The aim of this study was to evaluate the effects of acupuncture therapy to reduce the duration of postoperative ileus (POI) and to enhance bowel function in cancer patients. Methods A systematic search of electronic databases for studies published from inception until January 2017 was carried out from six databases. Randomized controlled trials (RCTs) involving the use of acupuncture and acupressure for POI and bowel function in cancer patients were identified. Outcomes were extracted from each study and pooled to determine the risk ratio and standardized mean difference. Results 10 RCTs involving 776 cancer patients were included. Compared with control groups (no acupuncture, sham acupuncture, and other active therapies), acupuncture was associated with shorter time to first flatus and time to first defecation. A subgroup analysis revealed that manual acupuncture was more effective on the time to first flatus and the time to first defecation; electroacupuncture was better in reducing the length of hospital stay. Compared with control groups (sham or no acupressure), acupressure was associated with shorter time to first flatus. However, GRADE approach indicated a low quality of evidence. Conclusions Acupuncture and acupressure showed large effect size with significantly poor or inferior quality of included trials for enhancing bowel function in cancer patients after surgery. Further well-powered evidence is needed.

Chewing gum for enhancing early recovery of bowel function after caesarean section.

Chewing gum for enhancing early recovery of bowel function after caesarean section.

MP38-19 READAPTATION OF THE PERITONEUM FOLLOWING EXTENDED PELVIC LYMPH NODE DISSECTION (PLND) AND CYSTECTOMY HAS BENEFICIAL IMPACT ON BOWEL FUNCTION IN THE LONG TERM WITHOUT COMPROMISING ONCOLOGICAL RADICALITY.

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2016MP38-19 READAPTATION OF THE PERITONEUM FOLLOWING EXTENDED PELVIC LYMPH NODE DISSECTION (PLND) AND CYSTECTOMY HAS BENEFICIAL IMPACT ON BOWEL FUNCTION IN THE LONG TERM WITHOUT COMPROMISING ONCOLOGICAL RADICALITY. Bernhard Kiss, Mihai Dorin Vartolomei, Alvaro Vidal Faune, George N. Thalmann, and Beat Roth Bernhard KissBernhard Kiss More articles by this author , Mihai Dorin VartolomeiMihai Dorin Vartolomei More articles by this author , Alvaro Vidal FauneAlvaro Vidal Faune More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.123AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Decrease in postoperative pain and earlier recovery of bowel function were achieved in patients after readaptation of the peritoneum following extended PLND and cystectomy. The aim of our study was to evaluate oncological outcomes and bowel function in the long term. METHODS Randomized, single center, single blinded, two-arm trial of 200 consecutive cystectomy patients who underwent PLND and cystectomy for bladder cancer <cT4, cN0, cM0 between April 2006 and September 2009. Postoperative follow-up was performed after 3, 6, 12 and 24 months, and annually thereafter. Bowel function was evaluated using questionnaires. Local recurrences and distal metastases were evaluated using computed tomography and bone scan 6, 12, and 24 months following surgery, and if clinically indicated. RESULTS Patients were randomized into two groups: group A with readaptation of the peritoneum and group B without readaptation of the peritoneum. (Table) Median follow-up was 59 months (range: 3 - 100). Five and 7 patients were lost to follow-up in group A and group B, respectively. There was no significant difference between the two groups in terms of rate of local (pelvic) recurrence (6/95 (6%) in group A; 6/93 (6%) in group B; p = 0.94), rate of distant metastases (20/95 (21%) in group A; 23/93 (25%) in group B; p = 0.67), tumour specific (p = 0.62) and overall survival (p = 0.51). Bowel function remained significantly better after readaptation of the peritoneum at 3 (p<0.001), 6 (p<0.001), 12 (p<0.02) and 24 months (p<0.03). Also, there was significantly less postoperative abdominal pain seen after readaptation of the peritoneum at 3, 6, 12 and 24 months (p < 0.001). CONCLUSIONS Readaptation of the dorsolateral peritoneal layer after extended PLND and cystectomy is an oncologically safe technique resulting in better bowel function and less abdominal pain in the long term. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e540 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bernhard Kiss More articles by this author Mihai Dorin Vartolomei More articles by this author Alvaro Vidal Faune More articles by this author George N. Thalmann More articles by this author Beat Roth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Extracorporeal vs. Intracorporeal Ileocolic Stapled Anastomoses in Laparoscopic Right Colectomy: An Interim Analysis of a Randomized Clinical Trial.

The role of intracorporeal anastomosis (IA) in right colectomy is still controversial. Primary endpoint of the present study is to evaluate the impact of IA versus extracorporeal anastomosis (EA) on recovery of bowel function and length of stay in right colon cancer patients. Adult patients with histologically proven cancer of the right colon were randomized to laparoscopic right colectomy with IA or EA anastomosis. Admitting a two-sided type I error level of 0.01 and an estimated power of 80%, 79 patients for each group were needed to test the primary endpoint. At the time of this interim analysis, 60 patients were randomized; 30 were assigned to the IA group and 30 to the EA group. The two groups were homogeneous with respect to demographics, American Surgical Association score, and tumor stage. In the IA group, a longer operating time (P = .04), an earlier recovery of bowel function (P = .048), and a lower incidence of postoperative ileus (P = .05) were observed. No differences were observed between the two groups with respect to length of stay (P = .70) and complication rate (P = .89). Anastomotic leak rate occurred in two patients in the IA group, while no leak occurred in EA. Intracorporeal anastomosis could be considered a valuable option in the hands of expert surgeons, with favorable effect on recovery of bowel function and postoperative ileus. Definitive answers on its safety and efficacy will be given once the present randomized controlled trial (RCT) will be complete.

Influence of Gum Chewing on Postoperative Bowel Activity After Complete Staging Surgery for Gynecological Malignancies

One important factor affecting early recovery in patients undergoing open complete staging surgery for gynecological malignancies is the return of normal bowel function. Gum chewing is a simple and inexpensive intervention that facilitates early recovery of bowel function in patients undergoing several types of gastrointestinal surgery. No previous study has investigated the possible favorable effects of gum chewing on return of bowel function in patients undergoing elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy. This randomized controlled trial was designed to assess the effectiveness of gum chewing for return of postoperative bowel function in patients undergoing abdominal complete staging surgery for gynecological malignancies. Participants were women undergoing abdominal complete surgical staging for various gynecological cancers. A total of 149 patients were randomized to a gum-chewing group (n = 74) or a control group (n = 75) who received no treatment. Gum chewing began on the first postoperative day. Patients chewed sugar-free gum 3 times daily until the first passage of flatus. Each session of chewing lasted 30 minutes. All patients underwent total abdominal hysterectomy and had systematic pelvic and para-aortic lymph node dissection as part of complete staging surgery. Postoperative outcome measures included time to first bowel movement, time to passage of first flatus and feces, time to tolerate oral feeding, need for antiemetics and analgesics, mild ileus rate, and length of hospital stay. There was significant improvement in the gum-chewing group compared with the control group for the following outcomes: mean time to bowel movement (41.5 ± 15.7 vs 50.1 ± 15.9 hours; P < 0.001), mean time to flatus (34.0 ± 11.5 vs 43.6 ± 14.0 hours; P < 0.001), mean time to defecation (49.6 ± 18.7 vs 62.5 ± 21.5 hours; P < 0.001), mean time to tolerate diet (4.0 ± 0.8 vs 5.0 ± 0.9 days; P < 0.001), and mean length of hospital stay (5.9 ± 1 vs 7.0 ± 1.4 days; P < 0.001). Mild ileus symptoms occurred in 27 patients (36%) in the control group and 11 patients (14.9%) in the gum-chewing group; the relative risk was 2.4 with a 95% confidence interval of 1.2 to 4.5; P = 0.004. Two patients (27%) in the control group had severe ileus symptoms. There were no adverse effects in the gum-chewing group. These data show that use of gum chewing early in the postoperative period following elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy hastens time to bowel recovery. Gum chewing reduced time to the first flatus and defecation, time to first bowel movement, and time to tolerate oral feedings. The investigators believe that this inexpensive and well-tolerated intervention should be added as an adjunct treatment in postoperative care of patients in this population.

SILS sigmoidectomy versus multiport laparoscopic sigmoidectomy for diverticulitis.

Background and Objectives:In this single-institution study, we aimed to compare the safety, feasibility, and outcomes of single-incision laparoscopic sigmoidectomy (SILSS) with multiport laparoscopic sigmoidectomy (MLS) for recurrent diverticulitis.Methods:Between October 2011 and February 2013, 60 sigmoidectomies were performed by the same surgeon. Forty patients had a MLS and 20 patients had a SILSS. Outcomes were compared.Results:Patient characteristics were similar. There was no difference in morbidity, mortality or readmission rates. The mean operative time was longer in the SILSS group (P = .0012). In a larger proportion of patients from the SILSS group, 2 linear staplers were needed for transection at the rectum (P = .006). The total cost of disposable items was higher in the SILSS group (P < .0001). No additional ports were placed in the SILSS group. Return to bowel function or return to oral intake was faster in the SILSS group (P = .0446 and P = .0137, respectively). Maximum pain scores on postoperative days 1 and 2 were significantly less for the SILSS group (P = .0014 and P = .047, respectively). Hospital stay was borderline statistically shorter in the SILSS group (P = .0053). SILSS was also associated with better cosmesis (P < .0011).Conclusion:SILSS is feasible and safe and is associated with earlier recovery of bowel function, a significant reduction in postoperative pain, and better cosmesis.