Return Of Bowel Sounds Research Articles

Gum Chewing on Accelerating the Bowel Motility after Caesarean Section

Background: Caesarean section is performed when it is indicated to prevent maternal and perinatal mortality and morbidity. However, it is associated with certain risks for complications that can hinder the comfort and early recovery after the surgery. Chewing gum as a form of sham feeding aids in resumption of gastrointestinal function among post caesarean mothers. Aim:The aim of the review is to determine the effect of gum chewing on accelerating the bowel motility in post caesarean section. Methods: Review search through PubMed, Google Scholar, Medline Plus and Scopus index. Results:Gum chewing gum provided a significant differences in early return of bowel sounds, time to first passage of flatus, time to feeling of hunger and shortening the length of hospital stay. Conclusion: Gum chewing might be a safe, and inexpensive way to provide the benefits of early stimulation of the gastrointestinal tract after caesarean section. Keywords: Gum chewing, intestinal function caesarean section and post caesarean mothers

Open Versus Laparoscopic Appendectomy: A Comparison of Outcome in a Teaching Hospital, Northeast Nigeria.

Appendectomy could be open or laparoscopic. Laparoscopic appendectomy (LA) is gradually gaining ground in Nigeria, but its outcome is not entirely known. This study compared the outcomes of LA with those of open appendectomy (OA) in terms of the surgical site infection rate, post-operative pain, time to return of bowel sounds, length of hospital stay, return to normal activities and direct cost of treatment. This was a prospective randomised study. All patients above 18 years who were diagnosed with acute appendicitis in Federal Teaching Hospital, Gombe, were recruited after adequate counselling and consent obtained over the 18 months of the study. Forty (40) patients were recruited with 20 on each arm. The average age was 25 years (±) 6 years and M:F was 1:1.9. The rates of surgical site infection and post-operative pain between both methods were not statistically different, while the time to return of bowel sound, the length of hospital stay and the return to normal activity were significantly reduced in LA compared to OA. However, OA was cheaper in terms of direct cost compared to LA. This study showed that LA may be the preferred method when a quicker recovery from treatment is anticipated, provided the patient can afford the direct cost of the procedure.

Comparison of robotic assistance and laparoscopy for pediatric choledochal cyst: advantages of robotic assistance.

Surgery for pediatric choledochal cyst (CC), complete excision (CE), and Roux-en-Y hepaticojejunostomy anastomosis (HJA) can be performed using laparoscopy (Lap), robotic-assistance (Rob; da Vinci Xi/Si), or both (Lap/Rob). Lap was used exclusively between 2009 and 2021 (n = 31) and Rob was introduced in 2017 (n = 23). All subjects were matched for age, weight, BMI, and episodes of preoperative pancreatitis. For Rob, the first 15/23 were Lap-CE/Rob-HJA and the last 8/23 were Rob-CE/Rob-HJA. Total anastomotic time (TAT), TAT per suture during HJA, and time taken for dissection during CE were significantly shorter with less variance for Rob, although overall operative times were similar. Serum amylase on postoperative days 3, 5, and 7 were significantly higher for Lap. Times taken to ambulate, for return of bowel sounds, and discharge home were all significantly shorter for Rob. All postoperative complications occurred after Lap; HJA leak (n = 1; 3.2%), HJA stricture (n = 1; 3.2%), both treated by open re-HJA; and pancreatic fistula (n = 6; 19%), all treated conservatively. Dissection and recovery were faster with Rob while overcoming Lap-associated shortcomings to prevent complications associated with suturing. Both CE and HJA were safer and more reliable with Rob, a reflection of Rob's superiority.

Post-Operative Benefits of Nasogastric Tubes in Patients with Gut Resection and Anastomosis: Myth or Reality?

Objective: To analyze the post-operative benefits of nasogastric tubes among patients undergoing gut resection and anastomosis at our surgical unit. Study Design: Prospective comparative study. Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2019 to Mar2020. Methodology: This study was conducted on 80 patients who underwent gut resection and anastomosis due to localized cause at surgical unit of our hospital. With block randomization method half of the patients received nasogastric (NG) tube after the surgery while half did not. Presence of nausea or vomiting, pain abdomen, return of bowel sounds and electrolyte imbalance were compared in both the groups. Results: Out of 80 patients included in the final analysis 50(62.5%) were male and 30(37.5%) were female. Mean age of patients put who underwent the gut resection and anastomosis procedure in our study was 41.34±5.147 years. Chi-square test revealed that all parameters included in the study did not differ significantly among patients with and without nasogastric tube after the surgery. Conclusion: Administration of nasogastric tube did not prove any better in reducing the post-operative abdominal pain, nausea and vomiting. It also did not prove to be effective in preventing the electrolyte imbalance and helping in returning the bowel sounds early. Patients with and without nasogastric tube had equal chance of having any of the complications.

Influence of Exteriorised versus Intra-abdominal Uterine Repair Caesarean Delivery under Spinal Anaesthesia on Intraoperative and Postoperative Complications

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair Group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version25. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p<0.001**). Mean drop in pulse rate, incidence of nausea, vomiting were similar in both the groups (p>0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group.

Pediatric Colonic Anastomosis: Can Method of Anastomosis and Wound Closure be of Help?

Enhanced recovery after surgery (ERAS) protocols after colorectal surgery focused on reduced bowel preparation, standardized feeding schedule, earlier return of bowel function, and earlier resumption of normal activities. ERAS in pediatric surgical practice is not well established. The present study aims to present the results of two colonic anastomosis techniques of interrupted single-layered closure: Halsted (Horizontal Mattress) and Matheson (serosubmucosal or appositional extramucosal) along with two different methods of colostomy wound closure and their influence on the adoption of ERAS protocol of early feeding and early discharge. This single institute-based randomized control study was conducted in a tertiary care facility in Kolkata for 2.4 years. Patients were chosen randomly for serosubmucosal (Group I) and full-thickness (Group II) anastomosis. Among total of 91 patients (Group I-43 and Group II-48), Return of bowel sounds and passage of bowel averaged 1.51 ± 0.51 and 1.91 ± 0.55 days in Group I and 1.91 ± 0.57 and 3.9 ± 0.66 days in Group II, respectively. Postoperative hospital stay averaged 5.88 ± 1.12 days in Group I and 8.9 ± 1.17 days in Group II. Overall 15 (16.48%) patients had complications among which SSI (Suprficial surgical site infection) and minor leaks (Group I-3 and 1 and Group II-5 and 3, respectively) which were treated conservatively (Clavien-Dindo Grade-I) and three major leaks under Group II requiring surgical intervention (Clavien-Dindo Grade-III). This study concludes that the technique of colostomy closure in the form serosubmucosal closure helps in the implementation of ERAS protocol by producing early bowel movement, early initiation of food, and less postoperative complications.

A COMPARATIVE STUDY OF STAPLERS VERSUS HAND SEWN ANASTOMOSIS IN INTESTINAL SURGERIES

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection & anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively

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.

Abdominal hysterectomy versus total laparoscopic hysterectomy in cases of enlarged uterine size

Background: Total laparoscopic hysterectomy (TLH) is a feasible, efficient way to manage benign uterine pathology, and is better than standard abdominal hysterectomy as it offers less postoperative discomfort, shorter hospitalization, rapid recovery, and early return to daily living activities.Methods: A retrospective comparative cohort study was done on patients with abnormal uterine bleeding due to large myomas in the Department of Obstetrics and Gynecology, Tanta University Hospital, Tanta, Egypt, and Institute of Obstetrics and Gynecology, Cagliari University, Cagliari, Italy. Participants were classified into two groups. Group I (Laparoscopy group) included 20 patients for whom TLH was done. Group II (Laparotomy group) included 20 patients for whom open hysterectomy (OH) was done.Results: Our result revealed that statistically significant differences were observed between the studied groups in post-operative Hb value, postoperative return of bowel sounds, and amount of blood loss however, prolonged duration of surgery was noticed in laparoscopic group than laparotomy group.Conclusions: TLH is an accessible technique and an alternative to laparotomy when it was done by experienced surgeons for large uteri regardless of the site, size.

Early versus Delayed Initiation of Oral Feeds among Mothers after Caesarean Delivery: A Comparative Study

Introduction: It is a common practice to keep a patient ‘nil’ per oral, till the return of bowel sounds, after any laparotomy. Enhanced Recovery After Surgery (ERAS) society, now recommends evidenced-based guidelines for postoperative early oral feeding after an uncomplicated Caesarean Delivery (CD), as opposed to the delayed (conventional) initiation of oral feeds. Aim: To compare the effects of early feeding versus delayed oral feeding in women undergoing CD. Materials and Methods: This prospective study was conducted in Department of Obstetrics and Gynaecology at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from November 2020 to October 2021. Total of 148 women with uncomplicated singleton pregnancy undergoing CD, under spinal anaesthesia, were allocated into two groups. Early Feeding group (n=70) (EF) where feeding was started within 2-8 hours of surgery and Delayed feeding group (n=78) (DF) where feeding was started between 18-24 hours of CD. The outcome measures were maternal satisfaction, and the effect on gastrointestinal function (return of bowel sounds, passage of flatus and stool), mobilisation of patient and complications in postoperative period. Student’s t-test and Chi-square test were used as appropriate, and p-value <0.05 was determined to be statistically significant. Results: The mean age of women in DF was 24.79±4.37 years and in EF group was 25.09±3.86 years. Overall, the maternal satisfaction was high in both the groups; DF (80%) and in EF (98.57%). There was an early return of bowel sounds in EF group 4.71±1.83 hours versus 13.72±3.08 hours in DF group. Participants in EF group recorded. early passage of flatus (9.89±3.00 hours versus 13.72±3.08 hours), and early ambulation (9.57±1.62 versus 14.95±3.9 hours) when compared to DF group participants. Conclusion: The ERAS strategy is a safe and effective approach for postoperative care for women undergoing caesarean delivery and results in overall high patient satisfaction.

Outcomes of management of intestinal obstruction at an urban tertiary hospital in sub Saharan Africa: a cross-sectional study

BackgroundIntestinal obstruction (IO) is a common cause of acute abdomen globally, it remains challenging as it increases surgical financial expenditure while also causing major morbidity. Clinically it presents with nausea, vomiting, colicky abdominal pain and cessation of bowel movements or passage flatus and stool. Diagnosis, especially in resource limited settings, can be clinical but is usually confirmed radiologically. We studied the current diagnosis, management and outcomes of IO in Mulago Hospital.Materials and methodsThis was a prospective study done at all the surgical units of Mulago from January to May 2014 to assess general diagnosis and management of IO. Ethical approval was got in line with Helsinki declaration, we used pretested and validated questionnaires to collect data. Informed consent was got with eligible and consenting/assenting patients that fitted the inclusion criteria of age and presenting with suspected intestinal obstruction. Uni-variate and bi-variate variables analysis was done plus measures of association.ResultsWe enrolled 135 patients, excluded 25 and recruited 110 patient. We had more males than females i.e. 71.8% males and 28.2% females. Colicky abdominal pain, abdominal distension, and vomiting were commonest symptoms, then abdominal distension, increased bowel sounds and abdominal tenderness were the commonest signs. Most patients’ (51%) were diagnosed radiologically with a lesser number clinically diagnosed. “Dilated bowel loops” was the commonest radiological sign. Surgery was the main stay of management at 72.7% while 27.3% were conservatively managed. Postoperatively the bowels opened averagely on the 3rd post-operative day (POD) with return of bowel sounds occurring on 5th POD. Most discharges (73%) occurred by the 7th POD. Unfavourable outcomes were prolonged hospital stay followed by wound sepsis (surgical site infection) and then Mortality.ConclusionThis study noted that In Mulago we mostly diagnosed patients radiologically with most surgically managed and which is similar to regional practices. Postoperatively bowel opening happening on third POD with return of bowel sounds on fifth POD. Prolonged hospital stay followed by wound sepsis and then mortality were commonest unfavorable management outcomes.

Evaluation of lignocaine, dexmedetomidine, lignocaine-dexmedetomidine infusion on pain and quality of recovery for robotic abdominal hysterectomy: a prospective randomized controlled trial

Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery.Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge.Results: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively.Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.

THE EFFECT OF SUCKING LOLLIPOPS ON RETURN OF BOWEL FUNCTION AFTER ELECTIVE DISTAL BOWEL SURGERY IN CHILDREN.

BACKGROUND-The phenomenon of cessation of coordinated bowel motility, commonly called as paralytic ileus is well known after certain surgeries. While procedures that involve direct manipulation of gut are almost always associated with post operative paralytic ileus, even orthopaedic surgeries may also cause post operative paralytic ileus. It contributes signicantly in prolonging hospital stay and is associated with abdominal distension, respiratory compromise, nausea and vomiting. Number of pharmacological and non pharmacological agents have been tried to reduce the post operative paralytic ileus. We studied the effect of sucking lollipop on the return of bowel function in children undergoing distal bowel surgery. AIM-To study effect of lollipop sucking on return of bowel function in children undergoing distal bowel surgery in terms of time to return of bowel, passage of stool per anal. MATERIALAND METHODS-Patients undergoing distal bowel stoma closure were assigned to two groups. The experimental group patients were given lollipops 6 hrs postoperatively, time to return of bowel sound and rst passage of stool was noted and analysed. RESULTS-Mean time to return of bowel sounds in the experimental group was 50.25 + 6.016 hrs, while in control group was 65.87 + 8.83 hrs, difference was statistically signicant (P&lt;0.0001).Mean time to passage of stools in experimental group was 72.312 +12.644 hrs , while in control group was 88.25 + 8.38 hrs. difference was statistically signicant(P=0.0002) . CONCLUSION- Sucking lollipop is a safe and effective in reducing duration of post operative paralytic ileus in paediatric patients undergoing elective bowel surgery.

A prospective study of outcome of resection anastomosis in elective GI surgeries.

Background: Bowel anastomosis is successful when there is accurate union with no tension.Previous literature has compared between hand suturing and stapling devices in retrospective andprospective designs with varying outcomes. In this study a comparison between hand suturing andsurgical stapling in patients undergoing bowel surgery is done. Methods: A prospective study designover a period of 12 months was conducted in 40 patients undergoing elective resection andanastomosis. Different time parameters for anastomisis procedure, time taken for bowel sounds toreturn, resumption of oral feeds, postoperative hospital stay were collected. Follow up for 30 dayspost-operative was done. Results: In total forty patients were studied out of which twenty patientsunderwent hand sewn and twenty patients underwent stapler anastomosis. Main group analysis inmean time durations between hand sewn and stapler anastomosis were respectively; 35.25 minutesand 12 minutes for anastomosis, 3.4 days and 3.35 days for return of bowel sounds, 4.08 days and4 days for resumotion of oral feeds, 9.35 days and 8.50 days for post-operative hospital stay. A sub-group analysis was also done.Conclusion: Stapler anastomosis had shorter anastomosis time andtotal duration of operation compared to hand sewn anastomosis. However no difference was seen inreturn of bowel activity, resumption of oral feeds and duration of hospital stay.

Early Versus Traditional Oral Hydration After Cesarean Section

Background: Traditionally, Patients are not given fluids or food after surgery until bowel functions returns.Objectives: To evaluate prospectively benefits and safety of ear1y hydration on bowel movement after CS.Materials and Methods: The current study was carried out at Ain Shams University Maternity Hospital on (290) pregnant women with term singleton pregnancy, uncomplicated Elective LSCS, time of CS doesn't exceed 90 Minutes, average blood loss during and after CS, All patients will be under spina1 anesthesia, during a period from March 01 to June 30, 2018.Results: The current study showed that among study groups: time to first intestinal sounds and time to first bowel movement were significantly shorter in early group (3.8±1.0 and 10.0±1.9, respectively), compared to (8.1±1.7 and 15.0±2.1, respectively) in traditional group. Also, amount of given IV fluids was significantly lower (2000ML) compared to (3250ML) in traditional group. No cases of paralytic ileus had been recorded among study groups.Conclusion: Early oral hydration after C.S was beneficial and safe on bowel movement, associated with faster return of bowel sounds, shorter time to bowel movement, less pain perception, higher satisfaction, less post-operative distension and earlier discharge.Recommendations: Early oral hydration can be conducted safely after CS. More population should be investigated for more global evaluation.

Single layer extramucosal versus double layer anastomosis for colostomy closure in children with anorectal malformation

Background: Intestinal anastomosis is one of the commonly performed procedure in gastrointestinal surgeries. The purpose of this study is to Assess safety, efficacy, cost effectiveness of single layer anastomosis over double layer anastomosis for colostomy closure in children with Anorectal Malformation at tertiary care centre. Materials and Methods: This prospective observational comparative study conducted between February 2016 to January 2021 consisting of 47 patients. All the children admitted for colostomy closure after definitive staged procedure for anorectal malformation were enrolled in the study. All anastomoses were of end-to-end type. The single layered anastomoses were performed by using interrupted 3-0 polydioxanone suture beginning at the mesenteric border and taking all layers of bowel wall except the mucosa into the bite. The double layered anastomoses were performed using interrupted 3-0 polydioxanone suture for the transmural inner layer and interrupted 3-0 polydioxanone Lembert sutures for outer seromuscular layer. Outcome parameters assessed were, quantity and cost of suture material used, time taken for anastomosis, time taken for surgery, postoperative return of peristalsis and passage of flatus, postoperative complications like paralytic ileus, bowel obstruction, anastomotic dehiscence diagnosed by presence of enteric contents like bile or faeces in drain or wound or diagnosed on radiological imaging like CT scans and hospital stay. Data were recorded in the case record form. Qualitative data was expressed in terms of proportions. Quantitative data was expressed in terms of Mean and Standard deviation. All the data collected was analysed by using SPSS 24.0 version IBM USA. Results: Out of total 47 children enrolled in study, 25 (53.19%)children were allocated to single layered extra mucosal intermittent anastomosis and 22 (46.81%) children to double layered anastomosis. All children admitted for colostomy closure had age ranges between 7 months to 36 months with mean age of 11.5 ±3.8 months.Amongst all the children undergoing anastomosis 35(74.47%) were males and 12(25.53%) were females. Observed outcome parameters like mean time taken for surgery in minutes (120.4±15.3 Vs 135.7±12.5), mean time taken for anastomosis in minutes (15.1±2.3 Vs 24.4±2.3), mean day of return of bowel sounds on postoperative day (2.40 Vs 3.74), mean day of first postoperative bowel movement (3.41 Vs 4.89 ) were significantly less in single layer anastomosis group than in double layer anastomosis. Suture material used in single layer anastomosis was lesser in quantity than used in double layer anastomosis. Post-operative complications were seen in 3 (06.38%) children of in single layer anastomosis group and 5 (10.63%) children of double layer anastomosis group. One child who underwent double layer anastomosis had anastomosis leak while none of child in single layer anastomosis group had leak. Mean duration of hospital stay was 5.95±1.40 days in single layer anastomosis group which is lesser than mean duration of hospital stay of 7.45 ± 1.95 days in double layer anastomosis group. Conclusion: Single layer intestinal anastomosis resulted in significant reduction in operative time, hastens the postoperative recovery of bowel function, reduces suture material, hospital stay and cost; without any difference in complications.

Comparison of early versus late enteral feeding following gut anastomosis.

Objectives: To compare early feeding versus late enteral feeding following gut anastomosis in term of hospital stay. Study Design: Prospective Randomized Control study. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: April to October 2017. Material &amp; Methods: All patients, excluding paediatric age group (n= 60) undergoing emergency or non-emergency gut resection with primary anastomosis were incorporated. Two strata were devised. Group A (n=30) received early enteral feeding starting at 12th post-operative hours in form of 100-150ml fluid thrice daily. Group B endured being Nil per oral for 72hrs. Both groups were correlated for timing of return of bowel sounds and timespan of hospital stay. P value &lt; 0.05 was considered noteworthy. Results: Overall 60 patients with 30 in each group were incorporated. They were predominantly males (55%) and belonged to middle age group (Group A=31.73+10.78 years; Group B= 36.00+10.53 years). Mean time for return of bowel sounds in both the groups was 24.40+5.88 hours and 35.20+10.88 hours respectively, which was striking (p value &lt;0.05). Mean length of hospital stay in both the groups was also noteworthy i.e. 5.23+0.72 days and 6.40+1.67 days respectively. Conclusion: In the wake of gut anastomosis, early oral feeding at 12hours is superior to delayed oral feeding after 72hours, in terms of mean time for return of bowel sounds and period of hospital stay.

Effect of abdominal massage on bowel evacuation in neurosurgical intensive care patients.

There are many factors, which affect the bowel evacuation of neurosurgical intensive care unit (NICU) patients, resulting in constipation. The aim of this study was to investigate effect of abdominal massage on bowel evacuation and the risk of constipation in NICU patients. A prospective, randomized-controlled clinical trial. The sample of this study included 80 NICU patients. The patients were randomly assigned to abdominal massage and control groups. The constipation risk of all the patients was assessed with Constipation Risk Assessment Scale (CRAS). The patients in the abdominal massage group received a total of 30 minutes of massage, 15 minutes every morning and evening, until the first defecation. The bowel sounds of all patients in the abdominal massage and control groups were assessed on a daily basis. The days when bowel sounds were heard and the first defecation took place were recorded in a Bowel Evacuation Form. The risk of constipation was higher in the patients in the abdominal massage (CRAS score 19.02 ± 1.81) and control groups (CRAS score 20.45 ± 2.61). The time of return of bowel sounds and the time of the first defecation were earlier in the abdominal massage group, compared to the control group (P< .05). In the control group, there was a weak correlation (P= .004) between the CRAS score and the time of return of bowel sounds, while there was a moderate correlation between the CRAS score and the time of the first defecation (P< .001). Our study results show that the risk of constipation is high in NICU patients, and abdominal massage is an effective nursing intervention to shorten the time of return of bowel sounds and the time of the first defecation. Nurses can safely apply abdominal massage to improve bowel evacuation in NICU patients.

Usage of Intravenous Lidocaine Infusion with Enhanced Recovery Pathway in Patients Scheduled for Open Radical Cystectomy: A Randomized Trial

Background: Intravenous lidocaine infusion (IVLI) reduces postoperative pain and hastens the return of bowel function. Objectives: We aimed to compare the effects of adding lidocaine infusion to enhanced recovery pathway (ERP) on acute rehabilitation protocol. Study Design: This study uses a double-blind, randomized design with allocation concealment in a 2-armed parallel group format among patients undergoing open radical cystectomy (RC). Setting: The study was conducted at Assiut University Hospital, Asyut, Egypt. The study duration was March 2017 to July 2018. Methods: After ethics committee approval, 111 patients, American Society of Anesthesiologists (ASA) physical status II-III, aged 45-65 years, scheduled for open RC with urinary diversion under an ERP, were randomly selected in a double-blind manner to receive IVLI 2 mg/minute for 4 hours or an equal volume of normal saline solution 0.9%. Postoperative pain scores, rescue analgesic consumption, times to return of bowel sounds, first flatus, first defecation, resuming of regular diet, length of hospital stay, in-hospital complications, and patient satisfaction were recorded. Results: Patients in the lidocaine group experienced significantly lower pain scores after surgery at 6 hours (P = 0.005) and 12 hours (P = 0.001) at rest, and in the first 18 hours during mobilization (P &lt; 0.05), with less paracetamol (P = 0.04) and meperidine (P = 0.02) consumption than in the control group. Between the lidocaine and the control group, mean times to return of bowel sounds (23.7 vs. 26.7 hours; P = 0.001), first flatus (76.5 vs. 86.5 hours; P = 0.001), first defecation (92.7 vs. 106.9 hours; P = 0.001) and resuming of regular diet (80.7 vs. 92.8 days; P = 0.001) were significantly shorter in the lidocaine group. Length of hospital stay, in-hospital complications, and patient satisfaction were similar in both groups. Limitations: Limitations of this study include lack of previous research that compare the additive effects of IVLI to ERP in patients undergoing open RC. Also, the inability to measure the serum lidocaine concentration in our patients. Conclusions: Adding IVLI to ERP improved postoperative analgesia and bowel function after open RC with urinary diversion. Clinical trial registration: NCT03047057. Key words: Lidocaine infusion, ileus, enhanced recovery pathway, acute rehabilitation, open radical cystectomy

Evaluation of Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Intraperitoneal Onlay Mesh Repair.

Introduction:Ventral hernia is a commonly performed surgical procedure in adults. Laparoscopic intraperitoneal onlay mesh repair (IPOM) of ventral hernia is procedure of choice. IPOM of ventral hernia is associated with significant pain. Hence, our aim was to study the efficacy of instilling preemptive local analgesia for reducing postoperative pain in patients undergoing laparoscopic ventral hernia repairs.Objective:To study the role of local infiltration of 10 ml of 0.5% ropivacaine in the anterior abdominal wall preoperatively to improve pain scores compared to conventional intravenous systemic analgesia.Materials and Methods:The study pool consists of two groups of patients (25 in each group) admitted for laparoscopic uncomplicated ventral hernia repair. Analysis was performed by the SPSS program (Company – International Business Machines Corporation, headquartered at Armonk, New York, USA) for Windows, version 17.0. Normally distributed continuous variables were compared using ANOVA. Categorical variables were analyzed using the Chi-square test.Results:Both groups were matching in terms of demographic features. Postoperatively, pain assessment was performed every 30 min for the first 2 h and was followed up for a period of 24 h at intervals (4, 6, 12, and 24 h). Postoperatively, patients were also assessed for time of ambulation, time of return of bowel sounds at 6, 12, and 24 h, and length of hospital stay. Side effects and complication were noted.Conclusion:Our study demonstrated that supplementing US-guided transversus abdominis plane (TAP) block to conventional systemic analgesics resulted in decreased VAS scores and decreased requirement of rescue analgesics. The patients ambulated early had earlier appearance of bowel sounds and decreased length of hospital stay. There was also decreased incidence of nausea and vomiting. TAP block for laparoscopic IPOM surgery significantly decreases postoperative pain and opioid requirement in patients.