Recovery Of Bowel Motility Research Articles

껌씹기가 복강경하 복부수술 환자의 장운동 회복에 미치는 효과

This study examine the effects of chewing gum on the recovery of bowel motility after laparoscopic-assisted abdominal surgery. This quasi-experimental study used a nonequivalent control group pre-post design. Data collection was conducted from January 1, 2018, to April 10, 2018. A total of 41 patients participated in the study. Forty-one patients undergoing laparoscopic-assisted abdominal surgery were assigned to either experimental group (n=21) or control group (n=20). The patients in the experimental group chewed gum for 30 minutes two times daily after the operation until the day they reported gas passing. Outcome variables were the time of bowel movement, time of the first passage of flatus, and time of the first defecation. The collected data were analyzed with frequency, percentage, Chi-square test and t-test by SPSS/WIN 18.0 program. This study showed that chewing gum was significantly effective in increasing the time of bowel movement and time of the first passage of flatus. but it was not effective in increasing the time of the first defecation. Chewing gum can be untilized as a safe and effective nursing intervention to reduce bowel movement and time of the first passage of flatus for patients with laparoscopic-assisted abdominal surgery.

The Effects of Abdominal Meridian Massage on Abdominal Distention, Pain, and Recovery of Bowel Motility after Sedated Colonoscopy

Purpose: This study investigated the effects of abdominal meridian massage on abdominal distention, abdominal pain, and bowel motility recovery after sedated colonoscopy.Methods: This quasi-experimental study was conducted from July 29, 2019 to September 10, 2019. Participants who underwent sedated colonoscopy at a general hospital in B city were assigned to experimental and control groups (n=27 each). The experimental group received abdominal meridian massage for 10 minutes at five acupoints (cheonchu, jungwan, gwanwon, gihae, daehoeng) post-colonoscopy. As outcomes, abdominal distention (subjective sensation of abdominal bloating and abdominal circumference), abdominal pain, and recovery of bowel movement (time of return of bowel sounds and passing gas post-colonoscopy) were measured. Data were analyzed using the independent t-test, x2 test, Fisher's exact test, analysis of covariance (ANCOVA), and repeated-measures ANCOVA using SPSS for Windows version 25.0.Results: Statistically significant between-group differences were found for subjective sensation of abdominal bloating (F=3.89, p<.024), abdominal circumference (F=11.05, p<.001), time of return of bowel sounds (x2=33.40, p<.001) and passing gas (x2=32.88, p<.001), but not abdominal pain.Conclusion: Abdominal meridian massage reduced abdominal distention and was effective for the early return of bowel function. Therefore, abdominal meridian massage can be used as a nursing intervention for relieving abdominal discomfort post-colonoscopy.

ROLE OF LOCAL HEMOSTATIC AGENTS AS ADJUVANT IN CONTROL OF PRIMARY POSTPARTUM HEMORRHAGE

Background: Hemostasis is an integral and very important aspect of surgical practice. In the developing world, about 1.2% of deliveries are associated with PPH and when PPH occurred about 3% of women died. Causes of postpartum hemorrhage are uterine atony, trauma, retained placenta or placental abnormalities, and coagulopathy, commonly referred to as the four Ts. Objective: To study the effect of gelfoam in hemostasis as adjuvant in control of primary postpartum hemorrhage. Patients and Methods: This was a Cohort study conducted at Sayed Galal University Hospital, Al-Azhar University Faculty of Medicine during the period from May 2019 to May 2020. A number of 60 cases of postpartum hemorrhage and role of gel foam in hemostasis as adjuvant in control of primary postpartum hemorrhage. Results: The findings of the present study indicate that local hemostatic agent “gel foam” was useful as adjuvant in control of primary postpartum hemorrhage in cesarean section. Local hemostats reduce the use of systemic hemostats, shorten the time required to achieve hemostasis. The delay in the recovery of bowel motility was due to the local hypersensitivity reaction caused by gelatin sponge and/or dislocation of this local hemostat. Conclusion: Local hemostatic agent “gel foam” was useful in adjuvant in control of primary postpartum hemorrhage in cesarean section.

Use of Gelatin Sponge Affects Postoperative Morbidity In Cesarean Section Patients.

BackgroundThis study aimed to determine the effects of use of a local hemostatic gelatin sponge (GS) on postoperative morbidity in patients undergoing cesarean section (CS).Material/MethodsThe records of 318 patients who underwent CS surgery were retrospectively evaluated. Group 1 consisted of 59 patients with gelatin sponge (GS) applied, and Group 2 consisted of 259 patients with no GS applied. The groups were compared for time to the first flatus, nausea and vomiting, requirement for anti-emetic drugs, development of postoperative ileus, and the length of hospitalization.ResultsThe patients in Group 1 and Group 2 were statistically similar in mean age, gravida, parity, and body mass index (BMI) (p=0.352, p=0.275, p=0.458, and p=0.814, respectively). No significant difference was determined in the number of patients with nausea, vomiting, anti-emetic drug use, febrile morbidity, and postoperative ileus (p=0.063, p=0.436, p=328, p=0.632, and p=0.179, respectively). Time to the first flatus and length of hospitalization were significantly longer in Group 2 (p<0.001 and p<0.001, respectively).ConclusionsDelay in recovery of bowel motility may be due to the local hypersensitivity reaction caused by GS and/or dislocation of this local hemostat. Women who receive gelatin sponge treatment during CS should be monitored closely for the recovery of postoperative intestinal motility.

Does enhanced recovery reduce postoperative ileus after colorectal surgery?

While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature. This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food. One hundred and thirty-one patients were included. A median of 14items (range: 13-16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2days and the GROT was 3days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P<0.001, r2=0.11 and P=0.04, r2=0.06). The incidence of postoperative "ileus" varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7days). Adherence to≥85% of the items in the ERAS protocol protected patients from "prolonged ileus", i.e., lasting≥4days (OR=0.35; 95% CI=0.15 to 0.83). The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.

Effects of Chewing Gum on Recovery of Bowel Motility after Laparoscopic Colorectal Surgery in South Korea

Effects of Chewing Gum on Recovery of Bowel Motility after Laparoscopic Colorectal Surgery in South Korea

Minimal Invasive Urologic Surgery and Postoperative Ileus

Postoperative ileus (POI) is the most common cause of prolonged length of hospital stays (LOS) and associated healthcare costs. The advent of minimal invasive technique was a major breakthrough in the urologic landscape with great potential to progress in the future. In the field of gastrointestinal surgery, several studies had reported lower incidence rates for POI following minimal invasive surgery compared to conventional open procedures. In contrast, little is known about the effect of minimal invasive approach on the recovery of bowel motility after urologic surgery. We performed an overview of the potential benefit of minimal invasive approach on POI for urologic procedures. The mechanisms and risk factors responsible for the onset of POI are discussed with emphasis on the advantages of minimal invasive approach. In the urologic field, POI is the main complication following radical cystectomy but it is rarely of clinical significance for other minimal invasive interventions. Laparoscopy or robotic assisted laparoscopic techniques when studied individually may reduce to their own the duration and prevent the onset of POI in a subset of procedures. The potential influence of age and urinary diversion type on postoperative ileus is contradictory in the literature. There is some evidence suggesting that BMI, blood loss, urinary extravasation, existence of a major complication, bowel resection, operative time and transperitoneal approach are independent risk factors for POI. Treatment of POI remains elusive. One of the most important and effective management strategies for patients undergoing radical cystectomy has been the development and use of enhanced recovery programs. An optimal rational strategy to shorten the duration of POI should incorporate minimal invasive approach when appropriate into multimodal fast track programs designed to reduce POI and shorten LOS.

Effects of Gum-chewing on the Recovery of Bowel Motility and Length of Hospital Stay after Surgery for Colorectal Cancer

Purpose: The purpose of this study was to examine the effects of a gum-chewing on the recovery of bowel motility and days of hospitalization after surgery for colorectal cancer. Methods: This study used a non-equivalent control group and non-synchronized design. Thirty-four patients undergoing abdominal surgery for colorectal cancer were assigned to either gum-chewing group (n=17) or control group (n=17). The patients in the gum-chewing group chewed gum for 10 min three times daily from the first postoperative morning until the day they began oral intake. Outcome variables were time of first flatus, time of first bowel movement, and length of hospital stay. Results: Gum-chewing was effective in enhancing the first passage of flatus, but was not effective in enhancing time of bowel movement and length of hospital stay. Conclusion: Gum-chewing can be utilized as a useful nursing intervention to shorten the time of the first flatus of postoperative colectomy.

Gum chewing stimulates early return of bowel motility after caesarean section

To evaluate the efficacy and safety of postoperative gum chewing on the recovery of bowel motility after caesarean section. A randomised controlled study. Faculty of Medicine, Ain Shams University, Egypt. A total of 200 pregnant women delivered by elective caesarean section (CS) under general anaesthesia. Women were randomised into two groups; group A (93 women) who received one stick of sugarless gum for 15 minutes every 2 hours after surgery, and group B (107 women) had traditional management (oral intake of clear fluids allowed after passage of flatus and regular diet with the passage of bowel movement). Time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement and length of hospital stay. The mean duration of surgery was longer in group A (41.3 +/- 7.5 versus 38.4 +/- 8.1 minutes, P < 0.05). The mean postoperative time interval to first hearing of normal intestinal sounds (10.9 +/- 2.7 versus 15.6 +/- 3.7 hours), passage of flatus (17.9 +/- 4.6 versus 24.4 +/- 7.1 hours), defecation (21.1 +/- 4.7 versus 30 +/- 8.2 hours) and discharge from the hospital (40.8 +/- 10.6 versus 50.5 +/- 8.9 hours) were significantly shorter in group A (P < 0.001). Severe ileus occurred only in one woman belonging to group B. All patients in group A tolerated gum chewing beginning on the first postoperative day. Gum chewing after CS is safe, well tolerated, and associated with rapid resumption of intestinal motility and shorter hospital stay; with potential impact on reducing the overall healthcare costs in case of routine implementation.

The effect of intrathecal medetomidine on small bowel transit in the rat.

Gastrointestinal motility is influenced by abdominal trauma, laparotomy and particularly by intestinal ischaemia. The reflex inhibition of gastrointestinal motility is mediated mainly by the sympathetic nervous system. There are reports on the effects of systemically applied alpha2-adrenoceptor agonists on gastric emptying and recovery of bowel motility, but the effect of spinally applied alpha2-adrenoceptor agonists on intestinal motility has not been studied. The aim of this study was to investigate the effects of intrathecal medetomidine on gastrointestinal transit in rats after transient intestinal ischaemia. Forty rats were randomly assigned to four groups of 10 each. Intrathecal catheter insertion and laparotomy were performed on each rat. Saline (10 microL) was injected intrathecally in Groups A and B. Medetomidine (10 microg in 10 microL) was injected intrathecally in Groups C and D. Intestinal ischaemia was induced in Groups B and D. Gastrointestinal transit was determined by measuring the length that a standardized marker meal of activated charcoal had travelled. Intrathecal medetomidine was compared to intrathecal saline in their effect on intestinal motility after 30 min period of bowel ischaemia. Laparotomy and intestinal ischaemia slowed gastrointestinal transit. Intrathecal medetomidine accelerated transit in both ischaemia and non-ischaemia groups. Intrathecal medetomidine markedly accelerated small intestinal transit and may also hasten the recovery from post-ischaemic paralytic ileus.

Invited Commentary

Malnutrition is well recognized as a potential cause of increased morbidity and mortality in surgical patients. Early postoperative enteral nutrition through a feeding jejunostomy has been shown to improve results in patients undergoing major resections for gastrointestinal malignancies, trauma, and perforation peritonitis. We conducted a prospective study to assess the feasibility and short-term efficacy of early enteral feeding through a nasoenteric tube placed intraoperatively in patients with nontraumatic perforation peritonitis with malnutrition. One hundred patients with nontraumatic perforation peritonitis with malnutrition undergoing exploratory laparotomy were randomly divided into a test group (TG) and a control group (CG) of 50 patients each. TG patients had a nasoenteric tube placed at the time of surgery and were started on an enteral feeding regime 24-hours postoperatively. Patients in CG were allowed to eat orally once they passed flatus. The differences between the two groups with respect to nutritional intake in terms of energy and protein, changes in nutritional status as assessed by anthropometric, biochemical, and hematological values, amount of nasogastric aspirate, return of bowel motility, and complication rates were analyzed. The nasoenteric feeding was well tolerated. Total calorie and protein intake in TG was significantly higher than in CG: 981 vs. 505 kcal (p < 0.01), protein 24 vs. 0 g on day 3 and 1498 vs. 846 keal (p < 0.01), protein 44 vs. 23 g (p < 0.01) on day 7, respectively. There was reduction in the amount of nasogastric aspirate in TG compared with that in CG: 431 vs. 545 ml/24 h on day 2 and 301 vs. 440 ml/24 h on day 3, respectively. There was much faster recovery of bowel motility in TG than in CG at 3.34 vs. 4.4 days (p < 0.01). Complications developed in 39 of 50 patients in TG and in 47 of 50 in CG. The major complications occurred in 6 patients in TG and 12 patients in CG (p < 0.05). Patients with perforation peritonitis with malnutrition are likely to develop large energy deficits postoperatively, resulting in higher incidence of infective complications. Early enteral feeding through a nasoenteric tube is well tolerated by these patients and helps to improve energy and protein intake, reduces the amount of nasogastric aspirate, reduces the duration of postoperative ileus, and reduces the risk of serious complications.

The effect of intrathecal medetomidine on small bowel transit in the rat

Background and objective: Gastrointestinal motility is influenced by abdominal trauma, laparotomy and particularly by intestinal ischaemia. The reflex inhibition of gastrointestinal motility is mediated mainly by the sympathetic nervous system. There are reports on the effects of systemically applied α2-adrenoceptor agonists on gastric emptying and recovery of bowel motility, but the effect of spinally applied α2-adrenoceptor agonists on intestinal motility has not been studied. The aim of this study was to investigate the effects of intrathecal medetomidine on gastrointestinal transit in rats after transient intestinal ischaemia. Methods: Forty rats were randomly assigned to four groups of 10 each. Intrathecal catheter insertion and laparotomy were performed on each rat. Saline (10 μL) was injected intrathecally in Groups A and B. Medetomidine (10 μg in 10 μL) was injected intrathecally in Groups C and D. Intestinal ischaemia was induced in Groups B and D. Gastrointestinal transit was determined by measuring the length that a standardized marker meal of activated charcoal had travelled. Intrathecal medetomidine was compared to intrathecal saline in their effect on intestinal motility after 30 min period of bowel ischaemia. Results: Laparotomy and intestinal ischaemia slowed gastrointestinal transit. Intrathecal medetomidine accelerated transit in both ischaemia and non-ischaemia groups. Conclusion: Intrathecal medetomidine markedly accelerated small intestinal transit and may also hasten the recovery from post-ischaemic paralytic ileus.

Recovery of Bowel Motility After High Dose Fentanyl or Morphine Anesthesia for Cardiac Surgery

Recovery of Bowel Motility After High Dose Fentanyl or Morphine Anesthesia for Cardiac Surgery

Recovery of bowel motility after high dose fentanyl or morphine anaesthesia for cardiac surgery

Recovery of bowel function was investigated after cardiac surgery. The time to first passage of flatus was measured using a carbon dioxide analyser as an indication of the return of coordinated bowel motility in 22 adult patients who received high-dose fentanyl (56.3, SD 20.9 micrograms/kg) or morphine (1.3, SD 0.7 mg/kg) anaesthesia. The time from the patient's arrival in the intensive care unit to passage of the first flatus in patients who received fentanyl anaesthesia was significantly longer than in those who received morphine (p less than 0.05). There was a significant relationship between the time to first flatus and the total dose of fentanyl, but no such relationship could be demonstrated for morphine. It is concluded that high-dose fentanyl anaesthesia delays recovery of bowel motility in a dose-dependent manner.