Recovery Of Peristalsis Research Articles

Nutritional support in patients with acute pancreatitis. Review of published studies

Acute pancreatitis is a common disease that occurs in 5—10% of patients with urgent pathology of the abdominal cavity. The most prevalent metabolic disorders affecting this group of patients are hypermetabolism and hypercatabolism syndromes, which are accompanied by excessive consumption of carbohydrates, fats, and amino acids, increased oxygen intake, and carbon dioxide production.
 Objective — to analyse the current state of the problem of nutritional support for patients with acute pancreatitis.
 The degree of nutritional disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease, necessitating a differential approach to their correction. Patients with acute pancreatitis experience disruption of the intestinal microflora due to the antibiotic therapy, nutrient and fiber deficiency, and lack of microbial antagonism. This disruption leads to excessive growth of bacteria, particularly gram‑negative microflora. The effectiveness and safety of enteral tube feeding are determined by a complex of factors: the timing of recovery of peristalsis and the absorption function of the intestinal wall, the type of mixture, and the method of its administration. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 hours after the start of complex conservative therapy. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum and reduce the frequency of intestinal complications on the 7th day by 21.5% (χ2=4.88, 95% CI 2.3—39.5, p=0.03). Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications (χ2=4.59, 95% CI 2.43—45.53, p=0.03), length of hospital stay by 16 days (p=0.04), and deaths by 21.4% (χ2=4.13, 95% CI 0.81—39.68, p=0.04) in comparison with parenteral nutrition. Nutritional support should be started with nasogastric administration of a food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.

Лікування та профілактика спайкової кишкової непрохідності в дітей

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence). Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children. Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on. Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO. Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate). Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo.

Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.

True peristaltic recovery is uncommon following treatment, particularly endoscopic dilation for achalasia cardia, though pseudo-recovery often occurs.

Relieving esophagogastric junction (EGJ) obstruction has been the focus of treatment for achalasia cardia. The recovery of peristalsis has been an elusive goal. Studies analyzing post-intervention peristaltic recovery have several limitations such as theuse of conventional manometry or lack of standard definitions of peristalsis. Accordingly, we undertook this study to analyze frequency and pattern of peristaltic recovery following treatment for achalasia cardia on high-resolution manometry (HRM) and standard Chicago definition of peristalsis. Pre and post-intervention HRM records of 71 treatment-naive patients diagnosed as achalasia cardia were retrospectively analyzed. Records with pre and post-intervention HRM on different systems (e.g. solid state and water perfusion) and those with inadequate information were excluded. All HRMs were interpreted as per Chicago classification version 3.0. After pneumatic dilation (PD) or laparoscopic Heller's myotomy (LHM), pseudorecovery of peristalsis was defined as any contraction at least 3cm in length along 20mmHg isobaric contour with a distal latency of less than 4.5seconds. True recovery and premature contractions were defined by standard Chicago classification v3.0 criteria. Change in diagnosis was observed in 38 of 71 (53.5%) patients after intervention. While pseudo-peristaltic recovery occurred in 11 of 71 (15.5%) patients, only three (4.2%) had a true recovery. Another nine (12.7%) patients showed new premature contractions. True peristaltic recovery is uncommon in achalasia cardia following intervention, particularly PD. Pseudo-peristaltic recovery is more common. Further research is warranted on this issue.

Accelerated rehabilitation after hysterectomy in reproductive age patients

Background and aims. The principles of enhanced recovery in operative gynecology, comorbidity, and a multimodal approach in perioperative support require comprehensive study and optimization, and the ambiguity of literature reports determines the relevance of this study. The aim of this study was to evaluate the parameters of perioperative monitoring after hysterectomy for uterine leiomyoma in patients of reproductive age using enhanced recovery after surgery protocols and their impact on quality of life indicators. Materials and methods. To evaluate the effectiveness of the enhanced recovery protocol after hysterectomy, two groups were formed: the main prospective group, which included 46 patients, who underwent vaginal hysterectomy without appendages and 36 patients with abdominal hysterectomy, who used enhanced recovery after surgery (ERAS) protocols. The comparison group (group of standard management) included 44 patients who underwent vaginal hysterectomy without appendages and 34 patients with abdominal hysterectomy. The main parameters of monitoring were the postoperative pain level, intraoperative blood loss, diuresis rate, the timing of urinary catheter removal and recovery of peristalsis, as well as individual activation of motor activity. Results. When using the principles of ERAS, the quantitative assessment of pain level (“absence of pain”) was 1.6 times more severe compared to the data of the comparison group; the timing of urinary catheter removal was 2.0 times shorter, drain removal – 2.7 times shorter, recovery of peristalsis – 1.9 times shorter and individual activation of motor activity – 2.9 times earlier than in patients of the comparison group. Conclusions. Studies have demonstrated the feasibility of using laparoscopic technology in combination with the ERAS, which demonstrates a fall in the volume of intraoperative blood loss, a decrease in blood and fluid balance, a shortening of the time of invasive intravascular intervention, allows to improve the course of the early postoperative period, relieve postoperative pain syndrome, reduce the risk of intestinal paresis, shorten the rehabilitation period, and, as a result, improve quality of life indicators.

The preventive effect of oral 76% Meglumine Diatrizoate for the postoperative ileus

ABSTRACT After emergency surgery for intestinal obstruction caused by colorectal cancer, postoperative ileus (POI) is more likely to occur in the early-stage oral intake. POI incited the occurrence of postoperative complications and prolongs hospital stay. Reducing the occurrence of POI will Enhance Recovery After Surgery (ERAS). Aim: The aim of this study is to observe and evaluate the preventive effect of postoperative oral administration of 76% Meglumine Diatrizoate in reducing the incidence of POI and promoting intestinal absorption during the recovery of intestinal peristalsis in patients after intestinal obstruction surgery. Methods: From October 2018 to December 2021, 94 patients (47 vs 47) with intestinalobstruction were rolled. Patients with an ASA score of 4 or higher and gastrointestinal perforation with peritonitis were excluded. After 24 hours of surgery, the patients were divided into experimental group and control group disposed of with an opaque airtight envelope method, patient-side single blind. After intestinal peristalsis recovery (2.45 ± 0.62 d vs 2.60 ± 0.68 d, P > 0.05), the experimental group was given 76% Meglumine Diatrizoate 20 ml orally 9am and the control group was given 10% glucose 20 ml for three consecutive days. POI cases, the time taken to achieve full daily oral calorie and discharge days were counted. Results: The time required to achieve full daily oral calorie (11.04 ± 2.70 d vs 14.09 ± 3.74 d, p < 0.05), POI cases (10/47 vs 20/47, p < 0.05) and discharge days (14.00 ± 4.89 d vs 16.77 ± 5.94 d, p < 0.05) are significantly different between the two groups. Conclusions: Oral 76% Meglumine Diatrizoate is safe and effective, which can reduce the occurrence of POI, promote the recovery of intestinal absorption and shorten the length of hospital stay effectively.

A comprehensive analysis of partial peristalsis recovery after peroral endoscopic myotomy in patients with achalasia.

To determine whether peroral endoscopic myotomy (POEM) improves esophageal peristalsis and to investigate the association between recovery of esophageal peristalsis after POEM and clinical features of the patients. In this single-center retrospective study, data were collected from medical records of the patients with achalasia who underwent POEM between January 2014 and May 2016. Demographics data, high-resolution esophageal manometry parameters, Eckardt score, and gastroesophageal reflux disease questionnaire (GERD-Q) score were collected. Weak and fragmented contraction was defined as partial recovery of esophageal peristalsis based on the Chicago classification version 3.0. Logistic regression analysis was used to identify variables associated with the partial recovery of peristalsis after POEM. A total of 103 patients were enrolled. Esophageal contractile activity was observed in the distal two-thirds of the esophagus in 24 patients. The Eckardt score, integrated relaxation pressure, and lower esophageal sphincter (LES) resting pressure were significantly decreased after POEM. Multivariate analysis revealed that preprocedural LES resting pressure (P = 0.013) and preprocedural Eckardt score (P = 0.002) were related to the partial recovery of peristalsis after POEM. Symptoms of gastroesophageal reflux and reflux esophagitis after POEM were less frequent in those with partial recovery of peristalsis (both P < 0.05). Normalization of esophagogastric junction relaxation pressure achieved by POEM is associated with the partial recovery of esophageal peristalsis in patients with achalasia. Preprocedural LES resting pressure and the Eckardt score are predictive of the recovery of esophageal peristalsis.

Nursing study on promoting the recovery of gastrointestinal peristalsis after laparoscopy in Obstetrics and Gynecology Department.

article: Nursing study on promoting the recovery of gastrointestinal peristalsis after laparoscopy in Obstetrics and Gynecology Department - Minerva Gastroenterology 2023 Jan 20 - Minerva Medica - Journals

Enteral nutrition in postoperative rehabilitation after reconstructive esophageal and gastric surgery

To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries. The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (n=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints. Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p<0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p<0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (p=0.034). Overall postoperative morbidity and mortality were similar. Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.

Impact of peroral endoscopic myotomy on high-resolution manometry findings and their association with the procedure’s outcomes

Peroral endoscopic myotomy (POEM) is conducted for patients with esophageal motility disorders based on high-resolution manometry (HRM) findings. However, the impact of POEM on HRM findings and the associations between post-POEM HRM and outcomes have not been clarified. In a multicenter, observational, cohort study, patients with achalasia treated by POEM received follow-up HRM. Associations between patient characteristics, POEM procedures, and post-POEM HRM findings, including integrated relaxation pressure (IRP) and distal contractile integral (DCI), were investigated. Furthermore, POEM procedure outcomes were compared with post-POEM HRM findings. Of 2171 patients, 151 (7.0%) showed residual high post-POEM IRP (≥26mm Hg; Starlet [Starmedical Ltd, Tokyo, Japan]). In a multivariate analysis, high pre-POEM IRPs (odds ratio [OR], 24.3) and gastric myotomy >2 cm (OR, .22) were found to be positive and negative predictive factors of high post-POEM IRPs, respectively. Peristalsis recovery (DCI≥500mm Hg/cm/s, at least 1 swallow; Starlet) was visible in 121 of 618 patients (19.6%) who had type II to III achalasia. High pre-POEM IRP (OR, 2.65) and DCI≥500 (OR, 2.98) predicted peristalsis recovery, whereas esophageal dilation (OR, .42) predicted a risk of no recovery. Extended myotomy did not reveal a significant impact on peristalsis recovery. High or low post-POEM IRP and DCI did not increase the incidence of clinical failure, reflux esophagitis, or symptomatic GERD. Extended gastric myotomy decreased IRP values, whereas peristalsis recovery depended on the characteristics of achalasia. A residual high post-POEM IRP does not necessarily mean clinical failure. Routine HRM follow-up is not recommended after POEM.

Intravenous lidocaine infusion in children

BACKGROUND: The problem of adequate analgesia in the early postoperative period is not relevant at present, both in our country and abroad because 50% of children experience pain after surgical interventions despite the ongoing therapy. Inadequate ideal method for assessing the pain syndrome severity, age restrictions with several drugs, and difficult communication with young children, as well as drug selection, lead to inadequate detection in pediatric practice.&#x0D; AIM: This study aimed to evaluate the effectiveness and safety of intravenous infusion of lidocaine in the early postoperative period in children operated on the abdominal cavity organs.&#x0D; MATERIALS AND METHODS: This study included 119 children who were randomized into 3 groups, in which intravenous lidocaine infusion, prolonged epidural blockade, or systemic fentanyl analgesia were used for pain relief after abdominal surgery. Hemodynamic parameters, respiratory system, pain intensity, resolution time of intestinal paresis, cortisol, glucose and lidocaine levels in blood plasma, and complications were monitored and compared intergroup.&#x0D; RESULTS: Lidocaine infusion had no effects on the hemodynamics and respiratory system in children. Cortisol level was markedly decreased through the day to baseline (32065 nmol/l). Early recovery of peristalsis corresponded to 233.75 h postoperatively. The pain syndrome intensity during the observation period did not exceed 2 points. The maximum level of free lidocaine in blood plasma was 2.811.31 g/ml, and the time spent in the intensive care unit (ICU) was 4810 h.&#x0D; CONCLUSION: Intravenous infusion of lidocaine after abdominal surgery in children is a safe method that provides effective pain relief, restores peristalsis early, and reduces the length of ICU stay.

Полікомпонентні колоїдно-гіперосмолярні розчини як ефективний компонент інфузійної терапії у хворих на гострий панкреатит

Стаття присвячена одному з найбільш тяжких та прогностично несприятливих гострих захворювань органів черевної порожнини — гострому панкреатиту. Наведені дані дослідження клінічної ефективності та ролі перфузійних розчинів у комплексному хірургічному лікуванні хворих із гострим панкреатитом на ранньому етапі лікування. Отримані результати дозволили зробити висновок, що включення перфузійних розчинів гідроксіетилкрохмалю у схему корекції гіповолемічних порушень сприяє стабілізації стану пацієнтів, чинить мікроциркулярний ефект та забезпечує раннє відновлення перистальтики.

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Прогнозування ризику розвитку післяопераційної злукової кишкової непрохідності в дітей

Esophageal Motility Patterns After Peroral Endoscopic Myotomy in Patients With Achalasia.

Background/AimsSeveral studies have reported partial recovery of peristalsis in patients with achalasia after myotomy. The aim of our study is to analyze esophageal motility patterns after peroral endoscopic myotomy (POEM) and to assess the potential predictors and clinical impact of peristaltic recovery.MethodsWe performed a retrospective analysis of prospectively collected data of consecutive patients with achalasia undergoing POEM at a tertiary center. High-resolution manometry (HRM) studies prior to and after POEM were reviewed and the Chicago classification was applied.ResultsA total of 237 patients were analyzed. The initial HRM diagnoses were achalasia type I, 42 (17.7%); type II, 173 (73.0%); and type III, 22 (9.3%). Before POEM, peristaltic fragments were present in 23 (9.7%) patients. After POEM the Chicago classification diagnoses were 112 absent contractility, 42 type I achalasia, 15 type II, 11 type III, 26 ineffective esophageal motility, 18 esophagogastric junction outflow obstruction, 10 fragmented peristalsis, and 3 distal esophageal spasm. Altogether 68 patients (28.7%) had signs of contractile activity, but the contractions newly appeared in 47 patients (47/214, 22.0%). Type II achalasia showed a trend for appearance of contractions (P = 0.097). Logistic regression analysis did not identify any predictors of peristaltic recovery. The post-POEM Eckardt score did not differ between patients with and without contractions nor did the parameters of timed barium esophagogram.ConclusionsMore than 20% of achalasia patients have signs of partial recovery of esophageal peristalsis after POEM. It occurs predominantly in type II achalasia but the clinical relevance seems to be negligible.

Pemberian kompres hangat efektif untuk pemulihan peristaltik usus pasien post operasi dengan anestesi umum

Background: Almost every patient with major surgery or surgery who uses general anesthesia after surgery does not take any action to help with intestinal peristalsis. Giving warm compresses is one way to reduce muscle spasms, increase and increase blood flow.Objectives: The purpose of this study was to study the solution of warm compresses to postoperative intestinal peristalsis recovery with general anesthesia.Methods: The design of this study was a quasi-experimental design with nonequivalent control group design, a sample of 16 respondents who were taken by consecutive sampling technique. The research was conducted at the Meuraxa Hospital Hospital Banda Aceh in 2019. The data was processed using statistical tests using paired sample t-test.Results: The results of the study have shown that there is the effectiveness of giving warm compresses to the recovery of peristalsis in the experimental group with a value of p= 0.000 (p &lt; 0.05), and the independent t-test shows that there is a significant difference in intestinal peristalsis between the experimental group and the control group in post patients. surgery under general anesthesia with a value of p= 0.022 (p &lt; 0.05).Conclusion: The effectiveness of warm compresses on the recovery of intestinal peristalsis in the experimental group and the control group in postoperative patients with general anesthesia. It is hoped that patients and nurses can apply warm compresses after surgery with general anesthesia

Real-time bowel sound analysis using newly developed device in patients undergoing gastric surgery for gastric tumor.

Background and AimObjective measurements are not available for determining bowel sounds. The present study sought to evaluate the efficacy of a novel bowel sound monitoring system for perioperative use in patients undergoing gastric surgery.MethodsThe study enrolled 14 patients who underwent surgery for gastric cancer at Kochi Medical School from 2017 to 2018. Preoperative and postoperative bowel sounds were recorded using a newly developed real‐time analysis system in the operating theater and recovery room. Clinical information and bowel sound count data were obtained to compare preoperative and postoperative measures.ResultsThe median preoperative and postoperative bowel sound counts across all patients were 1.4 and 2.5 counts per minute (cpm), respectively. In patients who underwent laparoscopic gastrectomy, the postoperative bowel sound count was significantly higher than that recorded preoperatively (2.3 vs. 1.6 cpm, P = 0.005). The findings also revealed a significant negative correlation between postoperative bowel sound count and operation time (r = −0.714, P = 0.003).ConclusionsThe real‐time bowel sound analysis system tested herein presents a promising diagnostic tool to quantitatively evaluate bowel movements associated with surgery. Our results suggested a need for shorter operation times for gastric procedures with respect to peristalsis recovery and supported the use of minimally invasive surgery.

Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study

BackgroundLaparoscopic appendectomy (LA) is a widely used surgical procedure. Patients often suffer from considerable postoperative pain and indigestion, which prolongs their in-hospital stay. Almost 10% of patients develop postoperative complications. The enhanced recovery after surgery (ERAS) program has proven its efficacy in elective surgery and could hypothetically improve LA outcomes. Currently, there is no ERAS program for LA.MethodsA modified ERAS (mERAS) protocol was studied in a prospective, randomized nonblinded clinical trial. The mERAS group consisted of 50 patients; the control group, of 54 patients. The mERAS protocol included a patient information brochure; minimizing drain use; local anesthesia; low-pressure pneumoperitoneum; early mobilization and oral diet. The primary outcome was postoperative length of stay (pLOS).ResultsModified protocol reduced median pLOS to 1.25 days vs 2 days in the controls (p < 0.0001). Twenty-one (42%) mERAS patients and 4 (7.4%) controls were discharged within 24 h (p < 0.001) after surgery; 0 readmissions were reported. Postoperative pain intensity assessed on the visual analogue scale was significantly lower in the mERAS group [mERAS vs control 0 h, 2 h, 6 h, 12 h and 24 h after surgery: 2.33 ± 2.12 vs 4.19 ± 2.08 (p < 0.0001), 2.27 ± 1.91 vs 4.02 ± 1.89 (p < 0.0001), 2.28 ± 1.98 vs 3.70 ± 1.57 (p = 0.0001), 1.98 ± 1.72 vs 3.43 ± 1.54 (p < 0.0001) and 1.80 ± 1.74 vs 3.00 ± 1.27 (p = 0.032), respectively)]. The severity of shoulder and neck pain was lower but its incidence was similar. Peristalsis recovery was achieved earlier in the study group (median (min–max))—mERAS 7 (2–34) h vs control 11 (3–43) h; p = 0.009) but did not affect the time of the first flatus 23 (2–72) h vs 29 (6–70) h, respectively; p = 0.499).ConclusionsThe modified ERAS program for LA has advantages over the traditional approach.RegistrationThis trial was registered at ClinicalTrials.gov as NCT03754777 (27/11/2018).

Esophageal aperistalsis and lung transplant: Recovery of peristalsis after transplant is associated with improved long-term outcomes

ObjectiveEsophageal aperistalsis has been considered a relative contraindication for lung transplant because of a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. We previously reported that esophageal motility improves in some patients after lung transplant. We reviewed the clinical course of lung transplant recipients diagnosed with an aperistaltic esophagus on pretransplant testing. MethodsWe identified patients diagnosed with pretransplant aperistaltic esophagus on high-resolution manometry who underwent lung transplant. Recipients with normal esophageal motility before lung transplant were used as the propensity score–matched control group. High-resolution manometry was repeated after lung transplant, and patients with aperistalsis were further divided into 2 subgroups: improved esophageal peristalsis and nonimproved peristalsis (ie, persistent aperistalsis after lung transplant). ResultsEsophageal aperistalsis was seen in 31 patients (mean age, 59.0 years; 21 men). The 1-, 3-, and 5-year post–lung transplant survivals in the aperistalsis group were 80.6%, 51.2%, and 34.9%, respectively, which was significantly lower than in the control group (90.3%, 73.4%, and 58.8%, respectively; P = .038). Post–lung transplant high-resolution manometry was performed for 29 patients in the aperistalsis group, 19 of whom demonstrated improved esophageal motility (65.5%). The 1-, 3-, and 5-year survivals after lung transplant of patients with recovery of peristalsis were similar to those of the control group (89.5%, 65.0%, and 48.8%, respectively; P = 1.000), whereas the nonimproved peristalsis group had lower survival (80.0%, 36.0%, and data unavailable, respectively; P = .012). ConclusionsEsophageal aperistalsis is not necessarily a contraindication for lung transplant. Improved peristalsis can be expected in up to two-thirds of these patients and is associated with good outcomes.

MOBILISASI DINI TERHADAP PEMULIHAN PERISTALTIK USUS DAN SKALA NYERI PASIEN POST PEMBEDAHAN

Postoperative complications such as pain, malnutrition, delayed wound healing and ileus were frequently found and become a challenge for health workers. Early mobilization is recognized as an approach that may help in preventing as well as decreasing the further effect of those complications. However, the implementation of early mobilization in hospitals were still limited to verbal commands without providing direct assistance to postoperative patients. Therefore, this study tries to give evidence-based nursing in PKU Muhammadiyah Gamping Hospital in improving nursing care to postoperative patient outcomes by giving early mobilization. The purpose of this study was to find the effect of early mobilization on the recovery time of intestinal peristalsis and pain scale in post-operative patients. This research was pre-experimental research using a static group comparison research design with a cross-sectional approach. The sampling technique used purposive sampling with specific criteria who was in adult age and received regional anesthesia. This study found 40 subjects consisting of 20 subjects in the intervention group and 20 subjects in the control group. The Mann-Whitney statistical test proved a significant effect on early mobilization on intestinal peristalsis recovery (p = 0.000) Gand pain scale (p = 0.001).

Su1143 – Pseudoachalasia Following Magnetic Sphincter Augmentation with Recovery of Peristalsis Following Dilation: A Case Report

Su1143 – Pseudoachalasia Following Magnetic Sphincter Augmentation with Recovery of Peristalsis Following Dilation: A Case Report