Period Of Postoperative Ileus Research Articles

Effect of Mosapride on Recovery of Intestinal Motility After Hand-Assisted Laparoscopic Colectomy for Carcinoma

Mosapride citrate (mosapride) is a serotonin 5-hydroxytryptamine 4 receptor agonist known to promote gastric emptying and large-intestine motility. We assessed the effect of mosapride on postoperative ileus following colon surgery. Forty patients with colon cancer undergoing hand-assisted laparoscopic colectomy were randomly assigned to a mosapride group or a control group. The mosapride group received 15 mg of mosapride by mouth with 50 ml of water three times a day, starting on postoperative day 1. The control group received 50 ml of water on the same schedule. Patients were allowed to resume oral feeding on the evening of postoperative day 2. Postoperative time to first bowel movement was evaluated by one investigator blinded to treatment. Postoperative gastric emptying was evaluated with the [(13)C]-acetate breath test at 24 and 48 hours after the operation. Postoperative time to first bowel movement was significantly shorter in the mosapride group than in the control group (48.5 vs. 69.3 hours, P = 0.0149). The time to maximal gastric emptying rate as determined by the breath test was significantly shorter in the mosapride group than in the control group at the 48-hour time point (27.9 vs. 35.3 minutes, P = 0.0294). Postoperative hospital stay was shorter in patients receiving mosapride than in controls (6.7 vs. 8.4 days, P = 0.0398). No adverse effects were observed with mosapride. Gastric emptying was improved by mosapride. The results suggested that the period of postoperative ileus following hand-assisted laparoscopic colectomy can be shortened by treatment with mosapride.

Congenital Bochdalek hernia presenting with acute pancreatitis in an adult

Posterolateral diaphragmatic hernias (Bochdalek) are a common congenital anomaly usually presenting in the neonatal period or infancy. Although well documented, their presentation in adulthood is uncommon. 1-3 We describe the case of an adult Bochdalek hernia presenting with acute pancreatitis and intermittent gastric volvulus.

New “sutureless” technique of ileostomy and colostomy

Brooke ileostomy and colostomy are associated with infection in the stomal and/or main wounds, leading to complications. The source of infection is feces from the open lumen. The objective of the present study was to find a way to prevent infection and subsequent complications. It was started in 1986 by serendipity after discovery that if wound contamination from intestinal contents is stopped in the immediate postoperative period, by a complete small/large intestinal obstruction, infection and complications are prevented. This study was based on the principle of delayed-primary wound closure. Following its initial discovery for a Brooke ileostomy, the procedure was used for both ileostomy and colostomy. The stapled stoma was fixed to the opening in rectus sheath. It was covered with an appliance that has a transparent pouch, allowing daily inspection. During the period of postoperative ileus, there is angiogenesis on the serosal surface, making it refractory to infection. The stoma tends to bulge with the appearance of peristalsis. Stoma was then opened with electrocautery in a bedside procedure. The mucosal cuff protrudes, everts, advances with peristalsis, and "grafts" itself on angiogenesis on the surface of a single layer of serosa. The advancing margin of the mucosal cuff fuses with the circumference of the opening in dermis. The maturation of the stoma is natural and automatic. Absence of sutures reduced the tissue trauma and foreign body reaction, resulting in better wound healing. This new procedure was named "delayed-primary self-maturation" (DPSM). Thirty seven colostomies and nine ileostomies were performed using DPSM. Infection in the stomal and/or main wound and subsequent complications were prevented. Delayed-primary self-maturation is technically easier and more scientific than a conventional ileostomy or colostomy and is recommended for all types of stomas.

Effects of Propranolol on Human Postoperative Ileus

Background: The sympathetic nervous hyperactivity present in response to surgical stress has been implicated as an important component of the postoperative paralytic ileus. A randomized and prospective study was conducted, evaluating the effects of the preoperative beta-adrenergic blockade with propranolol in schistosomotic patients during the period of postoperative ileus. Methods: The study compared schistosomotic patients submitted, or not, to beta-adrenergic blockade. Basal cardiac frequency was determined and propranolol was used in a dose of 40 mg twice a day. The dose was adjusted weekly until a minimum decrease of 20% in cardiac frequency was achieved. Three coupled bipolar electrodes were placed in the left colon in both groups, and registration of myoelectric activity of the left colon was made twice a day during the period of postoperative ileus using a system of data collection (DATA Q Series 200). The electric signals were previously amplified, filtered and separated into Electric Control Activity (ECA) and Electric Response Activity (ERA). Results: The dose of propranolol varied from 80 to 160 mg/day. The proportional decrease in basal heart frequency varied from 20 to 33%, with an average of 25.4 ± 3.9% in the propranolol group, maintaining a mean of 24.3 ± 3.6% decrease in the postoperative period. Differences on clinical recovery of the postoperative ileus were not found. Significant differences on electromyographic patterns were not observed between the groups, except for the presence of a greater number of short-duration contractions in the second postoperative day in the beta-blocked group. Conclusion: The authors suggest that the preoperative beta-adrenergic blockade with propranolol does not determine myoelectric activity changes that could contribute to an earlier resolution of postoperative ileus.

Electroacupuncture Analgesia in Major Abdominal and Pelvic Surgery: A Randomised Study

Proponents of acupuncture anaesthesia have tended to look on it as a replacement for conventional anaesthesia. This randomised, controlled trial involving 250 cancer patients undergoing abdominal or pelvic surgery, has aimed to assess the use of electroacupuncture as the sole analgesic, but within a standard anaesthetic. It was found that while there was little difference between the per-operative requirement for anaesthetic drugs, all the non acupuncture group required fentanyl, compared to only 5% of the electroacupuncture group (P<0.001). Time to spontaneous respiration (P<0.02) and extubation (P<0.001) immediately post-operatively was reduced in the acupuncture group. Transcutaneous electrical nerve stimulation (TENS) was used for post-operative pain relief in the acupuncture group, while the control group received non-narcotic analgesics. There was no significant difference in the numbers of patients complaining of pain, but the requirement for additional analgesia was less when TENS was used (P<0.01). There was no difference in the period of post-operative ileus as measured by the return of normal bowel sounds. However the return to normal self caring was significantly improved in the acupuncture group (P<0.02). Both practically and economically this is probably the most important beneficial aspect of electroacupuncture demonstrated by this study.

Does minimally invasive surgery result in a shorter period of postoperative ileus?

Does minimally invasive surgery result in a shorter period of postoperative ileus?

Selective repair of neonatal gastroschisis based on degree of visceroabdominal disproportion.

Based on 14 years' experience with the surgical repair of gastroschisis abdominal wall defects in 32 infants at the UCLA Hospital, certain aspects of care evolved which have served to reduce the overall long-term mortality to 6.2%. The severity of gastroschisis defects appears to be related to the length of time the eviscerated intestine has been exposed to amniotic fluid, and the degree of vascular obstruction to the viscera. In contrast to reports by previous authors recommending a specific operative technique for all infants with this malformation, we believe that choice of the optimal surgical repair depends on the degree of disproportion between the size of the eviscerated intestine and the size of the abdominal cavity. Three of the 32 patients with minimal disproportion underwent primary skin and muscle closure followed by early recovery. Twenty-seven who had primary skin flap closure later underwent secondary ventral hernia repair within six to 12 months. Two of the 32 infants had severe viscerobadominal disproportion and required temporary prosthesis coverage in addition to extensive skin flaps during the primary repair. The low morbidity and mortality following gastroschisis repair are apparently related to these factors: avoiding undue compression of the viscera; early coverage of the contaminated viscera with skin or muscle to minimize infection; careful supportive perioperative management to maintain body heat and provide adequate fluid repletion; and the infusion of intravenous hyperalimentation solutions during the lengthy period of post-operative ileus. Prosthetic materials should be reserved for more complex abdominal wall reconstruction in infants who have severe visceroabdominal disproportion.