Postoperative Paralytic Ileus Research Articles

Letter to the editor "Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis".

Letter to the editor "Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis".

Letter to the editor for the article "Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis".

Letter to the editor for the article "Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis".

Seven-year review of emergency peripartum hysterectomy in a tertiary hospital in northern Nigeria

Background: Emergency peripartum hysterectomy (EPH) is surgical removal of the uterus during childbirth or within its immediate 24 hours, a lifesaving procedure done as the last resort to control obstetric haemorrhage. Objectives: To determine the incidence, indications, and complications of peripartum hysterectomy. Methods: The study is a retrospective review of emergency peripartum hysterectomies performed at the Centre from 1st January, 2015 to 31st December, 2021. The patients’ case folders were retrieved from the medical records department and relevant information obtained using a structured data extraction format. The data was analyzed using SPSS version 26. Means, frequency, and percentages were used to present the significance of the results. Results: A total of 46 EPH were performed between January 2015 and December 2021 out of 20,832 deliveries within the same period, giving an incidence of 0.22% (2.2 per thousand deliveries). Indications were uterine rupture (78.2%), uterine atony (10.9%), abruptio placentae (4.3%), placenta previa (4.3%) and placenta accreta spectrum (2.2%). Subtotal hysterectomy was performed in most cases (39/46; 84.8%). The most common complication was intraoperative haemorrhage requiring blood transfusion (100%). Other complications included severe post-operative anaemia, wound sepsis, paralytic ileus and enterocutaneous fistula. The maternal case fatality was 4 (8.7%) and all the mortality cases were unbooked patients. Conclusion: The incidence of emergency peripartum hysterectomy is relatively low in our study and uterine rupture is the most common indication. EPH is associated with significant maternal morbidity and mortality, and this is related to booking status. Hence, enlightening women on antenatal care and hospital delivery will help in reducing maternal morbidity and mortality.

Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery - systematic review and meta-analysis.

Postoperative paralytic ileus (POI) is a significant concern following gastrointestinal tumor surgery. Effective preventive and therapeutic strategies are crucial but remain elusive. Current evidence from randomized-controlled trials on pharmacological interventions for prevention or treatment of POI are systematically reviewed to guide clinical practice and future research. Literature was systematically searched for prospective randomized-controlled trials testing pharmacological interventions for prevention or treatment of POI after gastrointestinal tumor surgery. Meta-analysis was performed using a random effects model to determine risk ratios and mean differences with 95% confidence intervals. Risk of bias and evidence quality were assessed. Results from 55 studies, involving 5078 patients who received experimental interventions, indicate that approaches of opioid-sparing analgesia, peripheral opioid antagonism, reduction of sympathetic hyperreactivity, and early use of laxatives effectively prevent POI. Perioperative oral Alvimopan or intravenous administration of Lidocaine or Dexmedetomidine, while safe regarding cardio-pulmonary complications, demonstrated effectiveness concerning various aspects of postoperative bowel recovery (Lidocaine: -5.97 [-7.20 - -4.74]h, P<0.0001; Dexmedetomidine: -13.00 [-24.87 - -1.14]h, P=0.03 for time to first defecation; Alvimopan: -15.33 [-21.22 - -9.44]h, P<0.0001 for time to GI-2) and length of hospitalization (Lidocaine: -0.67 [-1.24 - -0.09]d, P=0.02; Dexmedetomidine: -1.28 [-1.96 - -0.60]d, P=0.0002; Alvimopan: -0.58 [-0.84 - -0.32]d, P<0.0001) across wide ranges of evidence quality. Perioperative non-opioid analgesic use showed efficacy concerning bowel recovery as well as length of hospitalization (-1.29 [-1.95 - -0.62]d, P=0.0001). Laxatives showed efficacy regarding bowel movements, but not food tolerance and hospitalization. Evidence supporting pharmacological treatment for clinically evident POI is limited. Results from one single study suggest that Neostigmine reduces time to flatus and accelerates bowel movements (-37.06 [-40.26 - -33.87]h, P<0.0001 and -42.97 [-47.60 - -38.35]h, P<0.0001, respectively) with low evidence quality. Current evidence concerning pharmacological prevention and treatment of POI following gastrointestinal tumor surgery is limited. Opioid-sparing concepts, reduction of sympathetic hyperreactivity, and laxatives should be implemented into multimodal perioperative approaches.

Perioperative pain management with regional analgesia techniques for visceral cancer surgery: A systematic review and meta-analysis

Study objectiveRegional analgesia following visceral cancer surgery might provide an advantage but evidence for best treatment options related to risk-benefit is unclear. DesignSystematic review of randomized controlled trials (RCT) with meta-analysis and GRADE assessment. SettingPostoperative pain treatment. PatientsAdult patients undergoing visceral cancer surgery. InterventionsAny kind of peripheral (PRA) or epidural analgesia (EA) with/without systemic analgesia (SA) was compared to SA with or without placebo treatment or any other regional anaesthetic techniques. MeasurementsPrimary outcome measures were postoperative acute pain intensity at rest and during activity 24 h after surgery, the number of patients with block-related adverse events and postoperative paralytic ileus. Main results59 RCTs (4345 participants) were included. EA may reduce pain intensity at rest (mean difference (MD) -1.05; 95% confidence interval (CI): −1.35 to −0.75, low certainty evidence) and during activity 24 h after surgery (MD -1.83; 95% CI: −2.34 to −1.33, very low certainty evidence). PRA likely results in little difference in pain intensity at rest (MD -0.75; 95% CI: −1.20 to −0.31, moderate certainty evidence) and pain during activity (MD -0.93; 95% CI: −1.34 to −0.53, moderate certainty evidence) 24 h after surgery compared to SA. There may be no difference in block-related adverse events (very low certainty evidence) and development of paralytic ileus (very low certainty of evidence) between EA, respectively PRA and SA. ConclusionsFollowing visceral cancer surgery EA may reduce pain intensity. In contrast, PRA had only limited effects on pain intensity at rest and during activity. However, we are uncertain regarding the effect of both techniques on block-related adverse events and paralytic ileus. Further research is required focusing on regional analgesia techniques especially following laparoscopic visceral cancer surgery.

Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis.

Postoperative pain management following laparoscopic, non-oncological visceral surgery in adults is challenging. Regional anaesthesia could be a promising component in multimodal pain management. We performed a systematic review and meta-analysis with GRADE assessment.Primary outcomes were postoperative acute pain intensity at rest/during movement after 24h, the number of patients with block-related adverse events and the number of patients with postoperative paralytic ileus. 82 trials were included. Peripheral regional anaesthesia combined with general anaesthesia versus general anaesthesia may result in a slight reduction of pain intensity at rest at 24h (mean difference (MD) -0.72 points; 95% confidence interval (CI) -0.91 to -0.54; I2=97%; low-certainty evidence), which was not clinically relevant. The evidence is very uncertain regarding the effect on pain intensity during activity at 24h (MD -0.8 points; 95%CI -1.17 to -0.42; I2= 99%;very low-certainty evidence) and on the incidence of block-related adverse events. In contrast, neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) may reduce postoperative pain intensity at rest in a clinical relevant matter (MD -1.19 points; 95%CI -1.99 to -0.39; I2 = 97%; low-certainty evidence), but the effect is uncertain during activity(MD -1.13 points; 95%CI -2.31 to 0.06; I2= 95%; very low-certainty evidence). There is uncertain evidence, that neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) increases the risk for block-related adverse events (relative risk (RR) 5.11; 95%CI 1.13 to 23.03; I2= 0%; very low-certainty evidence). This meta-analysis confirms that regional anaesthesia might be an important part of multimodal postoperative analgesia in laparoscopic visceral surgery, e.g. in patients at risk for severe postoperative pain, and with large differences between surgical procedures and settings. Further research is required to evaluate the use of adjuvants and the additional benefit of regional anaesthesia in ERAS programmes. PROSPERO CRD42021258281.

A retrospective study comparing minimally invasive versus open surgical resection of small intestinal neuroendocrine neoplasms at a tertiary referral center

IntroductionNeuroendocrine neoplasms (SI-NEN) are the commonest malignancies of the small intestine. Traditionally, surgical treatment for SI-NEN has been open surgery. PurposeThe purpose of this study was to compare minimally invasive surgery (MIS) with the traditional open surgery approach for treating SI-NEN in a Swedish population. MethodsPatients with histopathological confirmed SI-NEN who underwent open surgery or MIS resection within 2009–2021 were extracted from the hospital's medical records. Results65 patients were included in this study, with 35 (54 %) undergoing MIS and 30 (46 %) undergoing open surgery. We found no statistically significant difference (p = 0.173) in the frequency of R0 resections (MIS group n = 34 (97 %), open surgery group n = 26 (87 %)). Nor was there a significant difference (p = 0.101) when comparing the median number of resected lymph nodes (MIS group n = 13.5, open surgery group n = 10). A post-operative paralytic ileus was more often reported (p = 0.052) in the MIS group (n = 9, 26 %) compared to the open surgery group (n = 2, 7 %). In light of this, the days of hospital stay did not differ significantly (MIS group median = 6, IQR (5–8), open surgery group median = 6, IQR (5–9)). The Kaplan-Meier analysis did not reveal differences concerning cancer-related deaths (p = 0.109). ConclusionThe results from this study support that a MIS approach for the treatment of SI-NEN may not be inferior to open surgery. The higher number of resected lymph nodes and R0 resections may even speak in favor for a MIS approach. More studies with a longer time of observation are needed to further support this conclusion.

Outcomes of anastomosis of mechanically prepared bowel vs. mechanically unprepared bowel in laparoscopic anterior resection in adult patients with rectal cancer

Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection of rectum (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in rectal surgery with MBP compared to cases where MBP is not utilized (no-MBP) in the context of LAR.Methods: This is a retrospective comparative study conducted in the professorial surgical wards of Teaching Hospital Karapitiya (THK). Rectal cancer patients (n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients where the postoperative complications and mortality rates were compared.Results: The anastomotic leakage rate was 2.6% (n=4) in the no-MBP group and 6.0% (n=9) in the MBP group, (p=0.143). Postoperative paralytic ileus rate was 18.5% (n=28) and 5.8% (n=9) in the MBP group and no-MBP group respectively displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. Overall mortality rate was 1.3% (n=3) in no-MBP group and 2.0% (n=2) in MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Primary sclerosing encapsulating peritonitis: a case report

BackgroundSclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge.Case presentationA 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved.ConclusionSclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

Study of the predictive factors affecting outcomes of patients undergoing transperitoneal laparoscopic donor nephrectomy.

We aim to study the preoperative and intraoperative factors and compare against specific outcomes in patients undergoing transperitoneal laparoscopic donor nephrectomy and see if we could find what were the predictive factors for these outcomes. This is a prospective cohort study done in a single high-volume transplant center. 153 kidney donors were evaluated over a period of 1year. The preoperative factors such as age, gender, smoking status, obesity, visceral obesity, perinephric fat thickness, number of vessels, anatomic abnormalities, comorbidities, and side of kidney and intraoperative factors such as lay of colon on the kidney, height of splenic or hepatic flexure of colon, loaded or unloaded colon, and sticky mesenteric fat were compared against specific outcomes such as duration of surgery, duration of hospital stay, postoperative paralytic ileus, and postoperative wound complications. Multivariate logistic regression models were used to study the variables of interest against the various outcomes. There were three positive risk factors for increased hospital stay, which were perinephric fat thickness and height of splenic or hepatic flexure of colon and smoking history. There was one positive risk factor for postoperative paralytic ileus which is lay of colon with relation to kidney and there was one positive risk factor for postoperative wound complication which was visceral fat area. The predictive factors for adverse postoperative outcomes after transperitoneal laparoscopic donor nephrectomy were perinephric fat thickness, height of splenic or hepatic flexure, smoking status, lay or redundancy of colon with relation to kidney and visceral fat area.

Meta‑analysis of randomized controlled trials comparing intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: upgrading the level of evidence.

Minimally invasive right hemicolectomy has been increasingly used for the treatment of right hemicolectomy disease, and both intracorporeal anastomosis (ICA) and extracorporeal anastomosis (ECA) are available to restore intestinal continuity. However, the advantages and disadvantages of these two anastomoses are highly controversial. The present meta-analysis evaluated the effectiveness of ICA versus ECA in minimally invasive right colectomy to improve the grade of evidence. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) comparing intracorporeal versus extracorporeal anastomosis in laparoscopic or robotic right hemicolectomy published from database inception to February 2023. Two researchers performed the literature review, data extraction, bias assessment, and meta-analysis of the data using Review Manager 5.4 software. Seven RCTs with a total of 750 patients were included in the meta-analysis. The results showed a lower incidence of postoperative paralytic ileus (RR 0.62, 95% CI 0.39 ~ 0.99, p = 0.04) and shorter incision length (MD - 1.38; 95% CI: - 1.98 ~ - 0.78, p < 0.00001), but longer operative time (MD 10.69; 95% CI: 2.76 ~ 18.63, p = 0.008). The remaining events including bleeding (RR 0.49, 95% CI: 0.12 ~ 2.04, p = 0.33), anastomotic leak (RR 0.62, 95% CI: 0.39 ~ 0.99, p = 0.85), surgical site infection (RR 0.15, 95% CI: 0.22 ~ 1.25, p = 0.15), overall perioperative morbidity (RR 0.86, 95% CI: 0.58 ~ 1.26, p = 0.44), number of harvested lymph nodes (MD 0.75; 95% CI: - 0.15 ~ 1.65, p = 0.10), and length of hospital stay (MD - 0.27; 95% CI: - 0.91 ~ 0.38, p = 0.42) were not statistically significant. Compared to ECA, ICA in minimally invasive right hemicolectomy reduced the risk of postoperative paralytic ileus and shortened the length of the incision but prolonged the operative time.

Association of the Controlling Nutritional Status Score with the Development of Postoperative Paralytic Ileus After Radical Cystectomy: Retrospective Cohort Study.

Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P = .055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P = .034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P = .027) were significant independent factors for postoperative paralytic ileus development. A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development.

The Efficacy and Results of Medical Treatment in Postoperative Ileus

Postoperative paralytic ileus refers to the disruption of the normal coordinated propulsive motor activity of the gastrointestinal system following surgery. Surgery causes inflammation in the muscle walls of organs with an intestinal lumen that, in turn, leads to a decrease in intestinal motility.The aim of this study was to investigate the efficacy of gastrografin, neostigmine, and their combined administration in patients diagnosed with paralytic ileus in the postoperative period.One-hundred twelve patients were included from January 2017 and November 2019. The retrospective study is involving prolonged postoperative ileus cases following colorectal surgery. The effect of gastrografin, neostigmine, and gastrografin neostigmine combination was compared retrospectively in the treatment of prolonged ileus after surgery.The study covered 112 patients. Gastrografin was administered to 63 patients; neostigmine was administered to 29, while 20 patients received the combination of the two. Data pertaining to the comparison of the two groups revealed that patients in the gastrografin group were discharged earlier than those in the neostigmine group. Further, patients in the combined group had earlier gas and/or stool discharge and were also discharged from the hospital earlier than those in the neostigmine group.Gastrografin and combined use of gastrografin and neostigmine are effective and viable methods for postoperative ileus cases. Gastrografin can safely be used in patients with anastomoses.

Risk Factors for Postoperative Paralytic Ileus in Advanced-age Patients after Laparoscopic Colorectal Surgery: A Retrospective Study of 124 Consecutive Patients.

Postoperative paralytic ileus (POI) is one of the most common and troublesome complications following colorectal surgery. However, to date, the risk factors for POI remain unclear. This study aimed to identify the risk factors for POI following laparoscopic colorectal surgery in advanced-age patients. The clinical data of 124 patients aged ≥75 years who underwent curative colorectal surgery from January 2018 to December 2020 were retrospectively reviewed. The relationship between POI and clinicopathological data including sarcopenia and visceral fat obesity was then assessed. Sarcopenia was defined as a low skeletal muscle mass index; visceral obesity, visceral fat with an area ≥100 cm2 on computed tomography at the level of the third lumbar vertebra; and sarcobesity, sarcopenia with visceral obesity. The rate of POI was 9% (12/124 patients), and all the affected patients improved with conservative treatment. In the univariate and multivariate analyses, sarcopenia and sarcobesity were significant predictive factors for POI. Sarcopenia and sarcobesity may be risk factors for POI in patients aged ≥75 years after laparoscopic colorectal surgery.

Gas detection in the portal vein after aortobifemoral bypass: a case report

We present a case report of early surgical treatment of abdominal compartment syndrome after aortobifemoral bypass. A 73-year-old man was admitted to the I.I. Mechnikov North-Western State Medical University with critical lower limb ischemia. Aortobifemoral bypass with a synthetic prosthesis was performed via laparotomy. The postoperative period was complicated by the dynamic bowel obstruction. The patient's condition worsened (hypovolemic and septic shock, respiratory failure due to severe pneumonia). Initial tactics was conservative. Signs of bowel ischemia (pneumatosis of the intestinal wall, gas in the portal vein) were identified using “point of care” ultrasound, which led to a change in the treatment tactics. On the same day, decompression relaparotomy was performed and the intestinal decompression tube was inserted. The postoperative period proceeded with positive dynamics: early extubation with acceptable parameters of gas exchange, minimal dosages of vasopressor support. Bowel function improved and stool appeared on the 2nd day after surgery.Gas in the portal vein is an ultrasound phenomenon, which in 70 % of cases suggests necrosis of the intestinal wall. The detection of such a symptom in patients after the abdominal aorta surgery may indicate bowel ischemia, since mesenteric circulation disorders primarily develop in the inferior mesenteric artery. This condition requires urgent surgical intervention, but its differential diagnosis with postoperative paralytic ileus is not always possible, especially in the early stages. We demonstrate a case of early gas detection in the portal vein and the emergency intervention that allowed preventing irreversible ischemic damage of the bowel. “Point of care” ultrasound can help suspect this condition and determine the indications for early surgical intervention, which can positively influence the outcome. Received 19 April 2022. Revised 29 May 2022. Accepted 1 June 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

"Prolonged Post-Operative Paralytic Ileus and Anastomotic Leak: Guilty or Not Guilty"

"Prolonged Post-Operative Paralytic Ileus and Anastomotic Leak: Guilty or Not Guilty"

Predictive factors of postoperative paralytic ileus following abdominal surgery: a clinical study

Background: Post-operative ileus is a surgical complication caused by impairment in the gastrointestinal motility with incidence range from 10 to 30%. The exact pathophysiology is not well understood although many authors suggested multifactorial relations that include surgical stress response electrolyte imbalances, and fluid overload. Objectives: to assess the risk factors associated with post-operative ileus, the technique of rapiddiagnosis and management strategies and the overall progress of the patient. Methods: a retrospective study was conducted from March 2019 to January 2020 on 499 patients who underwent abdominal surgery at two tertiary hospitals in the Taif city, Saudi Arabia. The data included baseline patient characteristics, history of previous surgeries, ASA classification, operative characteristics and postoperative outcomes and care patients received. Results: The findings showed that incidence of post-operative ileus was 12.4%. It was found that BMI&gt;25, cardiac diseases, history of previous abdominal surgery, chemotherapy, decreased preoperative albumin levels, surgeries involving gastrointestinal are a postoperative hypokalemia, and increased hospital stay &gt;3 days were found to be independent risk factors for post-operative ileus. Conclusion: Identification of risk factors of paralytic ileus before surgery not only helps to assess the surgical risk, but also helps in improving the postoperative management. This will in turn reduce the incidence of post-operative ileus. Keywords: predictive, postoperative, ileus, abdominal, surgery, Taif

A Systematic Review and Meta-Analysis of Harmonic Scalpel Versus Conventional Techniques of Appendiceal Stump Closure in Laparoscopic Appendicectomy.

Acute appendicitis is one of the most commonly encountered surgical emergencies worldwide. The laparoscopic approach for managing acute appendicitis is gaining popularity over open appendicectomy in the current surgical practice. The advantages of laparoscopic appendectomy are early recovery, fewer wound complications, less pain and better cosmesis. One of the most critical steps in laparoscopic appendicectomy is a secure appendicular stump closure. Life-threatening postoperative complications are often encountered following the breakdown of appendicular stump closure. There are several methods to achieve appendicular stump closure such as intra-corporeal knotting, endoloops, external corporeal knotting and pushing knot inside, endoscopic linear cutting stapler (endo GIA), and endoclips. A meta-analysis on the technique of appendicular stump closure in laparoscopic appendicectomy failed to demonstrate the superiority of one method over the other. In the last few years, many authors have evaluated the outcome of sutureless appendicectomy performed using devices like a harmonic scalpel. This systematic review and meta-analysis is aimed to summarise the current evidence regarding the utility and safety of harmonic scalpel in sutureless appendicectomy.This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic database, including Medline, Embase, CENTRAL, Scopus, Google scholar and clinical trial registry. Studies were selected and compared based on outcomes such as operative time, hospital stay, postoperative paralytic ileus, wound infection, and total complications. Statistical analysis was performed using the random effect model, fixed-effect model, pooled risk ratio, pooled mean difference and I2 heterogeneity.Four comparative studies with a total of 642 patients (376 male and 266 females) were included in the analysis. There were 359 patients in the conventional technique of appendicular stump closure group and 283 patients in the harmonic scalpel for appendicular stump closure group. Pooled analysis of the outcome measure of total complications showed that the use of harmonic scalpel for closure of appendiceal stump does not result in an increased incidence of complications as compared to the conventional technology of appendiceal stump closure. Pooled analysis of the outcome measure of mean operative time revealed a statistically significant reduction in the operative time in the patients where harmonic scalpel has been used for the management of appendiceal stump as compared to conventional methods (pooled mean difference of -12.96 with 95% CI -15.42, -10.50). Appendiceal stump closure during laparoscopic appendectomy by harmonic scalpel (HS) is comparable with the conventional techniques in terms of hospital stay, wound infection, postoperative paralytic ileus, and total complications. The use of a harmonic scalpel for closure of appendicular stump is associated with a reduction of the mean operative time of laparoscopic appendicectomy.

Postoperative paralytic ileus following debulking surgery in ovarian cancer patients.

AimThis study aims to evaluate the incidence of postoperative ileus (POI) following cytoreductive surgery in epithelial ovarian cancer (EOC) patients and its impact on anastomotic leakage occurrence and postoperative complications.MethodsA total of 357 surgeries were performed on 346 ovarian cancer patients between 1/2010 and 12/2020 at our institution. The postoperative course regarding paralytic ileus, anastomotic leakage, and postoperative complications was analyzed by Fisher's exact test and through ordinal logistic regression.ResultsA total of 233 patients (65.3%) returned to normal gastrointestinal functions within 3 days after surgery. A total of 123 patients (34.5%) developed POI. There were 199 anastomoses in 165 patients and 24 leakages (12.1%). Postoperative antibiotics (p 0.001), stoma creation (p 0.0001), and early start of laxatives (p 0.0048) significantly decreased POI, while anastomoses in general (p 0.0465) and especially low anastomoses (p 0.0143) showed increased POI rates. Intraoperative positive fluid excess >5,000 cc was associated with a higher risk for POI (p 0.0063), anastomotic leakage (p 0.0254), and severe complications (p 0.0012).ConclusionPostoperative antibiotics, an early start with laxatives, and stoma creation were associated with reduced POI rates. Patients with anastomoses showed an increased risk for POI. Severe complications, anastomotic leakages, and POI were more common in the case of intraoperative fluid balance exceeding 5,000 cc.

Molecular and cellular mechanisms underlying postoperative paralytic ileus by various immune cell types.

Postoperative ileus (POI) is a well-known complication following gut manipulation or surgical trauma, leading to an impaired gut motility and prolonged postoperative recovery time. Few current therapeutic strategies can prevent POI, and this disorder remains to be a major clinical challenge for patients undergoing surgery. Comprehensive understanding of cellular and molecular mechanisms related to the pathogenesis of POI stimulates the discovery of more promising targets for treatment. POI is closely associated with a series of inflammatory events within the bowel wall, and as key components of inflammatory mechanisms, different types of immune cells, including macrophages, dendritic cells, and T lymphocytes, play significant roles during the development of POI. A variety of immune cells are recruited into the manipulation sites after surgery, contributing to early inflammatory events or impaired gut motility. Our review intends to summarize the specific relationship between different immune cells and POI, mainly focusing on the relevant mechanisms underlying this disorder.