Time Of First Flatus Research Articles

Effects and Mechanisms of Transcutaneous Electrical Acustimulation on Postoperative Recovery After Elective Cesarean Section

To explore the effects and mechanisms of transcutaneous electrical acustimulation (TEA) on postoperative recovery after cesarean section (CS). A total of 108 women who underwent CS were randomized to receive TEA or sham-TEA. Four hours after CS, electrogastrogram (EGG) and electrocardiogram (ECG) were recorded for 30 min to assess gastric slow waves and autonomic functions, respectively. TEA at ST36 or sham-TEA at non-acupoints was performed for one hour right after recording ECG and EGG and then twice daily from postoperative days (POD) 1 to 3. In the morning of POD4, the EGG and ECG were recorded again for 30 min. TEA enhanced postoperative recovery associated with lower GI motility, reflected as a reduction in time of first flatus (p = 0.002) and time of first defecation (p < 0.001), an increase in the Bristol stool score (p < 0.001) and the number of SBMs (p < 0.001) in comparison with sham-TEA. TEA reduced symptoms associated with upper GI motility, including a reduction in time to resume semifluid (p = 0.008), and the total score of loss of appetite (p = 0.003) and belching (p = 0.038) from POD1 to POD3. Physiologically, TEA but not sham-TEA increased the percentage of normal gastric slow waves on POD4 compared with POD0 (p = 0.001). TEA reduced the visual analogue scale (VAS) pain score from POD1 to POD3 (p < 0.001). TEA but not sham-TEA increased vagal activity (p = 0.013) and decreased sympathetic activity (p = 0.013) on POD4 compared with POD0. Two factors were found to be independent predictors of shortened time of the first defecation: the use of TEA and a shorter surgical duration. Needleless non-invasive TEA at ST36 is effective in promoting both lower and upper GI symptoms after CS by enhancing vagal and suppressing sympathetic activities [Correction added on 23 June 2020, after first online publication: The first word of the preceded sentence has been corrected.].

The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer

BackgroundTo evaluate the feasibility and safety of a new surgical method, complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer.MethodsWe retrospectively analyzed and compared the data of consecutive patients with right-transverse colon cancer who underwent complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction (n = 23) and conventional complete laparoscopic extended right hemicolectomy (n = 34) in our hospital between October 2017 to May 2019, respectively.ResultsThe overall operation time of the ileocecal junction-preserved group was significantly shorter than that of the control group (p = 0.048). There was no difference in the number of harvested lymph nodes, metastatic lymph nodes, and rate of metastatic lymph nodes (p > 0.05). The ileocecal junction-preserved group showed shorter time of first flatus, lower frequency of postoperative diarrhea, and shorter duration of postoperative hospitalization. Furthermore, it also showed that the defecation frequency was lower in the ileocecal junction-preserved group than the control group on the 1st, 3rd, and 6th month (p < 0.05), and the number of patients who defecated at night or defecated four times or more a day was less in the ileocecal junction-preserved group than control group on the 1st month (p < 0.05).ConclusionThe complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction promises as a safe and feasible surgical procedure for right-transverse colon cancer, associated with earlier recovery of bowel function, shorter operation time, and similar pathological outcomes when compared to the conventional laparoscopic procedure.

Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study

BACKGROUNDSeveral studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Laparoscopic right hemicolectomy (LRH) is considered technically challenging. Robotic surgery has been introduced to overcome this technical limitation, but it is related to high costs. To maximize the benefits of such surgery, only selected patients are candidates for this technique. In addition, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities, who are usually more prone to post-operative complications.AIMTo investigate the outcomes of RRH vs LRH with regard to age and comorbidities.METHODSWe retrospectively analyzed 123 minimally invasive procedures (68 LRHs vs 55 RRHs) for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019. The surgical procedures were performed according to standardized techniques. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. Secondary outcomes were time to first flatus (TFF) and time to first stool evacuation. The robotic technique was considered the exposure and the laparoscopic technique was considered the control. Routine demographic variables were obtained, including age at time of surgery and gender. Body mass index and American Society of Anesthesiologists physical status were registered. The age-adjusted Charlson Comorbidity Index (ACCI) was calculated; the tumor-node-metastasis system, intra-operative variables and post-operative complications were recorded. Post-operative follow-up was 180 d.RESULTSLOS, TFF, and time to first stool were significantly shorter in the robotic group: Median 6 [interquartile range (IQR) 5-8] vs 7 (IQR 6-10.5) d, P = 0.028; median 2 (IQR 1-3) vs 3 (IQR 2-4) d, P < 0.001; median 4 (IQR 3-5) vs 5 (IQR 4-6.5) d, P = 0.005, respectively. Following multivariable analysis, the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function; in addition the dichotomous variables of age over 75 years and ACCI more than 7 were significant predictors of hospital stay. No outcomes were significantly associated with Clavien-Dindo grading. Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS (median 6 -IQR 5-8- vs 7 -IQR 6-12- d, P = 0.013) and later TFF (median 2 -IQR 1-3- vs 3 -IQR 2-4- d, P = 0.008), while patients with ACCI more than 7 were only associated with a prolonged hospital stay (median 7 -IQR 5-8- vs 7 -IQR 6-14.5- d, P = 0.036).CONCLUSIONRRH is related to shorter LOS when compared with the laparoscopic approach, but older age and several comorbidities tend to reduce its benefits.

Totally laparoscopic plus one transthoracic port esophagogastrectomy for Siewert-type Ⅱ adenocarcinoma of esophagogastric junction.

e16568 Background: The incidence of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG) is increasing, especially in Asia, but laparoscopic surgery for type Ⅱ AEG is not widely accepted due to the technical challenges and unknown prognosis. To address this problem, we developed a novel technique of totally laparoscopic plus one transthoracic port esophagogastrectomy. Methods: From May 2017 to December 2019, 24 patients with advanced Siewert type Ⅱ AEG underwent the procedure. The surgical technique is that after completely abdominal lymphadenectomy and mobilization of the stomach laparoscopically, the left diaphragm was incised 5 to 7 cm, followed by one transthoracic port was inserted into the thoracic cavity through the left axillary frontline at the sixth to eighth intercostal spaces. Then lower mediastinal lymphadenectomy and transection of the lower esophagus were completed through the transthoracic supplementary port. An intrathoracic Roux-en-Y esophagojejunostomy was performed also through this port, which was finally used for thoracic drainage. Results: All procedures containing 5 proximal gastrectomies and 19 total gastrectomies were completed successfully without surgical morbidity and mortality. The median operative time was 344 (205 to 540) min. The time for reconstruction was 38 (25 to 60) min. The median blood loss was 100 (20 to 300) ml. The median tumor diameter was 3.8 (1.5 to 6.7) cm with a median esophagus invasion of 2.5 (0.6 to 4.5) cm. The median number of lymph nodes harvest was 37 (18 to 60). The median number of lower mediastinal lymph nodes was 5 (1 to 13) and its metastasis rate was 33.3%(8/24). The median time of first flatus was 4 (2 to 7) days. The median hospital stay was 11 (7 to 45) days. One patient developed a thoracic infection and one esophagojejunostomy leakage, both cured with thoracic drainage and antibiotic treatment. The median follow-up was 22(1-32). The DFS was 83.3% and OS was 91.7%. Conclusions: Our initial result suggested that this novel technique was safe and feasible for Siewert type Ⅱ AEG, associated with the advantages of complete lower mediastinal lymphadenectomy and easy intrathoracic Roux-en-Y esophagojejunostomy by using the transthoracic assisted port.

Functional jejunal interposition versus Roux-en-Y anastomosis after total gastrectomy for gastric cancer: A prospective randomized clinical trial

BackgroundNutritional status and quality of life deteriorate significantly after total gastrectomy for patients with gastric cancer. The numerous types of reconstruction proposed by medical researchers around the world have limited effect. This prospective, randomized clinical trial compared functional jejunal interposition with Roux-en-Y anastomosis to identify the optimal reconstruction procedure. MethodsThis was a multi-center, prospective, randomized control trial. The enrolled patients were randomly assigned into the functional jejunal interposition group and the Roux-en-Y group. All patients were followed up at regular intervals after surgery. The endpoints were postoperative nutritional status, quality of life, and long-term postoperative complications. ResultsA total of 113 patients were enrolled from August 2012 to September 2017. Until March 2018, the median follow-up period was 18 months. At 12 months after surgery, food intake per meal (P = 0.021), Prognosis Nutritional Index (P = 0.015), weight loss (P = 0.019), and Gastrointestinal Symptom Rating Scale score (P = 0.015) of the functional jejunal interposition group were significantly worse than those of the Roux-en-Y group. There was no significant difference in operative time, intraoperative blood loss, perioperative complications, time of first flatus and defecation after surgery, postoperative plasma nutritional parameters, Visick score, Eastern Cooperative Group physical condition score, and survival rate. ConclusionFor patients with long-term survival after total gastrectomy for gastric cancer, the Roux-en-Y anastomosis is a better choice compared with functional jejunal interposition.

Efficacy of Celiac Branch Preservation in Billroth-Ⅰ Reconstruction After Laparoscopy-Assisted Distal Gastrectomy

BackgroundThe goal of the present retrospective study was to elucidate the efficacy of conserving the celiac branch (CB), which can reduce the adverse reactions of Billroth-Ⅰ (B-Ⅰ) restoration after the laparoscopy-assisted distal gastrectomy (LADG). MethodsTwo hundred thirty-three patients with gastric cancer underwent B-Ⅰ reconstruction after LADG with dissection 2 lymphadenectomy from July 2005 to July 2012 and were monitored for 5 y. The patients were separated into 2 groups: celiac branch preserved (P-CB) group (n = 98) and celiac branch resected (R-CB) group (n = 135). In addition to patient information, tumor features, and surgical details, short-term and long-term variables such as bowel condition, surgical complications, and endoscopy findings were evaluated. ResultsIn short-term efficacy, the time of first flatus and liquid ingestion were slightly shorter in the P-CB group than in the R-CB group (3.84 ± 0.74 versus 4.38 ± 0.71, P = 0.0001; 5.04 ± 1.07 versus 5.67 ± 1.10, P = 0.0001). For long-term efficacy, the incidences of chronic diarrhea, gastroparesis, residual food, bile reflux, and reflux esophagitis were less in the P-CB group compare with the R-CB group (6.1% versus 22.2%, P = 0.001; 5.1% versus 17.8%, P = 0.004; 4.1% versus 17.8%, P = 0.004; 8.2% versus 17.8%, P = 0.036; 8.2% versus 17.8%, P = 0.036). Other parameters such as postoperative ileus and gallstones had a better efficacy trend in the P-CB group but did not suggestively vary among the groups. ConclusionsThe CB has an imperative part in the gastrointestinal motility, and celiac preservation mainly exerts long-term efficacy in patients who underwent B-I surgery with LADG.

Effect of early oral feeding on gastrointestinal motility in patients undergoing colorectal resection: a meta-analysis of randomized clinical trials

Background: The use of early oral feeding (EOF) to enhance the recovery of gastrointestinal (GI) motility after elective colorectal cancer surgery remains controversial. There was no updated meta-analysis to determine the efficacy and safety of this invention. Methods: Randomized controlled trials (RCTs) were identified from PubMed, Embase, and the Cochrance Central Register of Controlled Trials (CENTRAL). Eleven RCTs (1,216 participants) were included in our meta-analysis. Results: The EOF was associated with a shorter time of first flatus (MD =−0.58, 95% CI: −0.70 to −0.47, P&lt;0.00001, I 2 =19%), shorter first defecation (MD =−0.79, 95% CI: −1.00 to −0.59, P&lt;0.00001, I 2 =0%), and reduced length of hospital stay (MD =−1.48, 95% CI: −2.11 to −0.85, I 2 =78%) compared to conventional oral feeding (COF). There was no significant difference between the EOF and COF group in the incidence of nausea, vomiting, nasogastric tube (NGT) reinsertion, the risk of wound infection, and the occurrence of pneumonia and anastomotic dehiscence. The risk of total postoperative complications was much lower in the EOF group than the COF group [relative risk (RR) 0.59, 95% CI: 0.48 to 0.73, I 2 =46%, P&lt;0.00001]. Conclusions: Our findings suggest that EOF is appropriate for patients after elective colorectal cancer surgery and it is good for the recovery of GI motility.

Safety of early oral feeding after total laparoscopic radical gastrectomy for gastric cancer (SOFTLY-1): a single-center randomized controlled trial.

Objectives: The aim of this study is to explore the safety and feasibility of early oral feeding (EOF) on short-term postoperative outcomes.Trial design: A prospective randomized non-inferiority trial.Materials and methods: From August 27, 2015 to March 31, 2017, 100 consecutive patients with gastric cancer in Xijing Hospital were recruited. Patients undergoing total laparoscopic radical gastrectomy (TLRG) received either EOF group or delayed oral feeding (DOF group). The endpoints were anastomotic leakage, the recovery of bowel function, the postoperative complications and costs. The process of randomization used a computer-generated sequence that was kept in a sealed envelope by a nurse that did not participate in the trial. None of the participants, administrators of interventions and those assessing outcomes was blinded.Results: Ultimately, 51 patients were in EOF group and 49 in DOF group, which both are comparable. The postoperative hospital stay in EOF group was significantly lower than DOF group (5.18±1.47 days vs 6.18±2.46 days, P=0.016). Furthermore, there was a trend for a reduction in the time of first flatus (10.3 hrs) and defecation (12.7 hrs) in EOF group compared to DOF group, but it was not statistically significant. Meanwhile, there were no significant differences in postoperative complications between two groups. One patient in the EOF group developed a fistula in the surgical remnant, which was recorded as other leakages; there was no difference between the two groups (P=0.582).Conclusion: EOF does not seem to be more harmful than DOF, and might significantly improve the short-term outcomes for patients receiving TLRG.

Laparoscopic versus open splenectomy plus portaazygous devascularization in the treatment of patients with portal hypertension with recurrent upper gastrointestinal bleeding

Objective To compare the efficacies of laparoscopic versus open splenectomy plus portaazygous devascularization in the treatment of patients with portal hypertension with recurrent upper gastrointestinal bleeding. Methods The clinical data of patients who underwent laparoscopic (n=60) versus open (n=52) splenectomy plus open portaazygous devascularization in the Department of Hepatobiliary Surgery, the Center Hospital of Xianyang City, Xi'an Jiaotong University Health Science Center from March 2014 to February 2017 were retrospectively analyzed. Results There was no perioperative death in the 2 groups. The amounts of intraoperative bleeding, the durations of the operation, the time of first flatus passed after operation and the duration of postoperative hospitalization were compared, and the differences were significantly different (t=3.288, 2.533, 3.325, 2.823, P 0.05). The incidence of postoperative complications was significantly higher in the open surgery group (χ2=7.622, P 0.05). On gastroscopy, the esophageal and gastric varices were significantly improved, and there was no significant difference between the two groups (χ2=0.718, P>0.05). Liver function was better in the laparoscopic group than the open group (χ2=3.765, P 0.05) were not significantly different. Conclusion Compared with laparotomy, laparoscopic splenectomy plus portaazygous devascularization had the advantages of less trauma, better short-term and long-term efficacies. Key words: Portal hypertension; Recurrent bleeding; Splenectomy; Portaazygous devascula-rization; Laparoscopic surgery; Surgical treatment

THE USE OF LIDOCAINE INFUSION FOR ANALGESIA AND PREVENTION OF ILEUS AFTER MAJOR ABDOMINAL SURGERIES

Objective. To assess the effect of infusion of lidocaine solution in patients after extensive abdominal operations. Material and methods. Were examined 42 patients with cancer of the pancreas, which is made pancreatoduodenal resections. The patients were divided into two comparable groups. Patients of the first group (n=21) before surgery injected bolus 1.5 mg/kg lidocaine, followed by infusion at a rate of 1.5 mg/kg*h during the first 24 hours after surgery. Patients of the second group (n=21) started epidural infusion of 0.2 % ropivacaine solution at a rate of 5 ml/h. The intensity of pain syndrome was evaluated on VAS at rest and during mobilization, bowel actions, the time of first flatus and first stool, the need for additional analgesics and lenght of stay in the intensive care unit. Results. The intensity of pain in the first day was significantly (p

Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial.

The aim was to compare the effectiveness of chewing sugar-free gum after bowel resection on bowel function and length of stay. This was a randomized controlled trial of patients undergoing elective open or laparoscopic bowel surgery, who were allocated into two groups: a chewing gum group (CG); or a nonchewing gum group (NG). Primary outcomes were time to discharge (length of hospital stay [LOS]), time to first flatus (TFF) and time to first bowel motion (TBM). Secondary outcomes were complication rates, pain and total morphine equivalent (TMEq) medication for 7days after the procedure. Between 2010 and 2013, 162 patients were randomized; four were excluded, leaving 158 in the study (82 in the CG and 76 in the NG). There was no difference in LOS between the CG (5.8days) and the NG (6.1days) (P=0.403) or in the median TFF between the CG (42.0h) and the NG (58.0h) (P=0.076). The median TBM was lower in the CG (40.0h) than in the NG (90.0h) (P=0.002). There was no difference in intra-operative complications between the CG (9%) and the NG (9%) (P=0.901) or in early postoperative complications (44% for CG and 55% for NG) (P=0.131). There was no difference in TMEq at 24h postprocedure, but the CG had reduced TMEq from days 2 to 7 post procedure and for the 7-day total. Pain was higher among patients in the NG on day 3. Chewing sugar-free gum resulted in an earlier return to bowel function and decreased analgesic requirements. There was no decrease in overall LOS or postoperative complications.

The use of chewing gum for postoperative ileus prevention in patients undergoing radical cystectomy

ABSTRACTDoes the postoperative use of chewing gum in patients undergoing radical cystectomy (RC) facilitate intestinal motility recovery, reduce intestinal recanalization times and decrease length of stay? Postoperative ileus is a temporary impairment of intestinal motility and a frequent complication after RC. It is characterized by abdominal distention and absence of bowel functions, with symptoms including nausea, vomiting, pain and cramps. This results in an increase in length of stay, patient discomfort and costs. Different studies investigated the efficacy of chewing gum use, as a form of simulated feeding, in accelerating the resolution of ileus after several abdominal surgical procedures. Considering the lack of specific studies, some other conducted in similar abdominal procedures were included in this literature review. Despite the diversity of type of surgery, all considered studies show for patients who received chewing gum, a significant reduction in the time of first flatus and faeces, a reduction in the time of first bowel movements; not all included studies instead have found a significant decreasing in morbidity and length of stay. The chewing gum use seems to be a simple and inexpensive way to enhance recovery of bowel function, although it is probably still a little known procedure. It is possible recommending the administration of chewing gum in patients after cystectomy, monitoring the effectiveness, upon the recognition of possible conditions that might contraindicate its use.

LAPAROSCOPY WITHIN MULTIMODAL OPTIMIZATION PROGRAMM IN PATIENTS WITH COLORECTAL CANCER

AIM to assess the efficacy of combination of laparoscopy and protocol of enhanced recovery in patients with colorectal cancer. MATERIALS AND METHODS. Between 2008-2016 466 patients were randomly allocated into 3 groups. Of them 266 of received perioperative treatment according to enhanced recovery protocol, 191 had routibne open procedure (group 2) and, 75 had laparoscopic operation (group 1). Patients underwent the following procedures: right hemicolectomy (n=53), left hemicolectomy (n=32), sigmoidectomy (n=55), abdomeno-perineal excision (n=67) and low anterior resection of rectum(n=201), other operation - 58. The following variables were analized: operating time, intraoperative blood loss, time of first flatus and defecation, morbidity (wound infections, anastomotic leakage, peritonitis, postoperative ileus, urinary disorders, thrombosis, cardiopulmonary complications). RESULTS. Groups were comparable in gender, comorbidities, body mass index, types of operations. Operating time did not differ significantly between 3 groups. Intraoperative blood loss was higher in conventional group. The time offirstflatus and defecation were better in group 1 and 2. Mortality rate was similar. Morbidity was lower in group 1 and 2 compared with conventional group: wound infections 1,3%, 3,1% vs 9%, anastomotic leakage 4%, 5,5% vs 9%, ileus 1,2 vs 5,4%, peritonitis 2,6%, 1,5% and 3,5%, bowel obstruction caused by the adhesions 0%, 6,8% vs 5,5%. Reoperation rate was 4%, 4,7% vs 5,5%, consequemntly. CONCLUSION. Combination of laparoscopic surgery withenhanced recovery program provides better results of treatment.

Various fashions of laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction.

e22512 Background: Laparoscopic surgery for small (&lt;5 cm) gastric gastrointestinal stromal tumors (GIST) is now widely performed. However, laparoscopic resection of GIST in esophagogastric junction is technically difficult. Herein, we introduce various fashion of laparoscopic resection for small GIST in esophagogastric junction. Methods: Retrospective review of 40 consecutive patients with small GIST in esophagogastric junction who underwent attempted laparoscopic surgery. GIST in esophagogastric junction was defined as that the distance of the upper border of GIST from esophagogastric line was less than 2 cm. Three fashions of laparoscopic resection were performed: fashion A, laparoscopic wedge resection using linear stapler; fashion B, laparoscopic complete resection by opening the stomach wall and the stomach wall incision was closed with suture; fashion C, laparoscopic proximal gastrectomy with pyloroplasty. The data of clinicopathologic characteristics, operative course and short-term outcomes were analyzed. Results: All procedures were finished successfully and no operative relatively complication was recorded. Tumor in 24/40 (60%) patients was located in greater curvature. 70.1% (17/24) of them received fashion A and others (7/24) underwent fashion B. Tumor in 16/40 (40%) patients was located in lesser curvature. 18.8% (3/16) of them underwent fashion C and others (13/16) underwent fashion B. The mean operative time was 97.4±21.3 min and the mean estimated blood loss was 20.5±10.4 ml. The mean first time of flatus was 39.2±10.0 hours and the time of fluid intake was 40.1±11.7 hours. The mean hospital stay was 4.2±1.3 days. The mean diameter of tumor was 2.7±1.0 cm. Conclusions: Laparoscopic surgery for small GIST in esophagogastric junction is safe and feasible. The selection of various laparoscopic resection fashions was according to the tumor location.

Effects of early oral feeding on postoperative recovery of patients undergoing gastrointestinal surgery: a Meta-analysis

Objective To evaluate the effects of early oral feeding on postoperative recovery of patients undergoing gastrointestinal surgery. Methods CNKI, China Biology Medicine database (CBM) , PubMed, Embase, The Cochrane Library and Web of Science databases were screened. Randomized controlled trials (RCTs) and their references from 2006 to 2016 were recruited using Meta-analysis. RevMan 5.3 software was used for data processing. Results A total of 11 RCTs containing 2 188 patients were included in the study. In patients with early oral feeding compared to patients with traditional fasting, there were statistically significant differences in first time of flatus[MD=-0.90 d, 95%CI (-1.12, -0.67) , P 0.05], abdominal distension[RR=1.29, 95%CI (0.70, 2.36) , P>0.05], the total incidence rate of postoperative complications[RR=0.82, 95%CI (0.59, 1.15) , P>0.05]and non-infective complications[RR=0.78, 95%CI (0.49, 1.25) , P>0.05]. Conclusions Early oral feeding is beneficial to the recovery of gastrointestinal function in patients with digestive system diseases, and significantly reduces the infective complications. Key words: Fasting; Gastrointestinal tract; Early oral feeding; Post operation; Meta-analysis

Intravenous lignocaine infusion facilitates acute rehabilitation after laparoscopic colectomy in the Chinese patients.

Intravenous infusion of lignocaine has emerged in recent years as a feasible, cost-effective, and safe method to provide postoperative analgesia. There is, however, no literature about this perioperative pain control modality in Chinese patients. This study aimed to determine whether perioperative intravenous lignocaine safely reduces postoperative pain, shortens postoperative ileus, and reduces the length of hospital stay in laparoscopic colorectal surgery. Between September 2012 and May 2015, 16 patients who underwent elective laparoscopic resection of colorectal cancer and received a 1% lignocaine infusion for 24 hours postoperatively were studied. After surgery, categorical pain scores were obtained immediately, followed by hourly pain scores at rest. Pain scores at rest and with mobilisation, and patient satisfaction score were documented on postoperative day 1. Return of bowel function was measured by time of first flatus and bowel opening. The patient's rehabilitation was assessed by time taken to tolerate diet, full mobilisation, and length of hospital stay. The median (interquartile range) self-reported pain scores at 2 hours and 6 hours after surgery were 1.5 (0-4) and 2 (0-3), respectively. The median pain scores at rest and mobilisation on postoperative day 1 were 1 (0-2.5) and 2 (2.5-5), respectively, with a median satisfaction score of 7.5 (7-9). The median times to first flatus and first bowel opening were 21 (18-35) hours and 3 (1-3) days, respectively. No patient had postoperative ileus. The median times to tolerating diet and mobilisation were 1 (1-1) day and 2 (2-3) days, respectively. The median postoperative stay was 6 (5-8) days. Intravenous lignocaine is a safe and effective postoperative analgesic in a Chinese population. It enhances the rehabilitation process for patients following laparoscopic resection of colorectal cancer.

Effects of self-made traditional Chinese medicine concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section

Objective To explore the effects of self-made traditional Chinese medicine (TCM) concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section. Methods A total of 300 parturients with cesarean section were selected as subjects from July 2014 to December 2015 and were randomly divided into three groups including group A (100 cases, sponge bath and feet bath with TCM), group B (100 cases, feet bath with warm water), group C (100 cases, without intervention) with informed consent according to bed numbers. We observed the volume of lochia, height of fundus, the time of first flatus, milk yield, sleep quality, length of stay among groups after childbirth. And then, we explored the effects of self-made TCM concentrate for sponge bath and feet bath on postpartum recovery in parturients with cesarean section by comparing indicators among groups. Results The volume of lochia, height of fundus, the time of first flatus, milk yield, sleep quality in group A were better than those in group B and C with significant differences (P<0.05) along with the length of stay in group A 0.5-1 d less than that in group B and C. Conclusions The self-made TCM concentrate for sponge bath and feet bath can reduce the length of stay and contribute to reducing the volume of lochia post partum, promoting the involution of uterus and intestinal peristalsis, increasing the milk yield, improving sleep quality, relieve postoperative pain so as to promote postpartum recovery. Key words: Cesarean section; Postpartum recovery; Foot bath; Sponge bath; Traditional Chinese medicine concentrate

The Effect of Warm Water Intake on Bowel Movements in the Early Postoperative Stage of Patients Having Undergone Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

This study was aimed at determining the effect of oral administration of warm water during the postoperative initial stage on the time of first flatus in patients who had undergone laparoscopic cholecystectomy. In the literature, it is emphasized that warm water has favorable effects on intestinal movements such as "reliving gastrointestinal spasms and helping peristalsis return." This randomized controlled trial and experimental study was conducted in a university hospital between May and December 2011. In the study sample, we included a total of 60 patients; 30 were in the experimental group (drank warm water), while the other 30 composed the control group. Patients were randomized through a simple random sampling method. The experimental group was provided with 200 ml of warm water at 98.6°F (37°C) in the fourth postoperative hour and were made to drink it within 15 minutes. Patients received no oral intake other than warm water until the eighth postoperative hour. The oral feeding of both groups started in the eighth postoperative hour with fluids and soft food. They shifted to the normal diet as tolerated. In the analysis of the data and percentage numbers, chi-square test and Fisher's exact test, Student's t test, Mann-Whitney U test, Kruskal-Wallis variance, and correlation analysis were used. The results of the data were considered reliable and statistically significant when they were in the reliability interval of 95% and p < .05. No significant differences were found between the patients in the experimental and control groups in terms of demographic features, bowel habits, surgery durations, postoperative applications, nausea/vomiting conditions, and initial mobilization times (p > .05). Groups were homogeneously distributed. Flatus expulsion in the experimental group was 11 ± 4.2 hours and was determined to be 18.6 ± 6 hours for patients in the control group (p < .05); in contrast, no significant difference was detected in terms of the times of stool defecation (p > .05). It was determined that warm water intake in the fourth postoperative hour significantly decreased the first flatus expulsion period and had a favorable impact on intestinal movements.

Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial.

AimTo study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients.MethodsEighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21), FTS + laparotomy group (Group B, n=21), conventional perioperative care (CC) + laparoscopic group (Group C, n=21), and CC + laparotomy group (Group D, n=21). Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.ResultsPreoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05). There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05). Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.ConclusionFTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction, and hence is safe and effective for elderly GC patients.

Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility

Study objectiveTo compare sugammadex with conventional reversal of neuromuscular block in terms of postoperative gastrointestinal motility. DesignDouble blinded, randomized, controlled clinical trial. SettingOperating room, postoperative recovery area. PatientsSeventy-two patients with ASA physical status I or II, scheduled for total thyroid surgery were studied. InterventionsWhen 4 twitches were observed on train-of-four stimulation, neuromuscular block was reversed conversatively in the control group, and with sugammadex in the study group. MeasurementsTime to first flatus and feces, incidence of postoperative nausea, vomiting, diarrhea and constipation were collected. Main resultsMedian time of first flatus was 24 hours (18-32 [10-36]) in the neostigmine group, and 24 (18-28 [12-48]) in the sugammadex group (P > .05). Median (IQR) time of first feces was 24 hours (18-36 [10-48]) in neostigmine group, 32 hours (28-36 [12-72]) in sugammadex group (P > .05). There were no occurrences of nausea, vomiting, diarrhea, or constipation. ConclusionsSugammadex may be safely used in cases where postoperative ileus is expected.