Abstract
A substantial percentage of patients undergoing colorectal surgery develop prolonged postoperative ileus (PPOI). Since the data on its incidence and risk factors in patients undergoing laparoscopic colorectal surgery with ERAS protocol are sparse, we aimed to analyse them in a group of 295 consecutive patients operated on laparoscopically for colorectal cancer. The study was a prospective observation of 295 patients. In all of them, the 16-item ERAS protocol was applied. The primary outcome was the occurrence of PPOI. Secondary outcomes were risk factors of PPOI. PPOI incidence rate was 9.8%. In 8 (27.6% of PPOI group) patients, it was secondary to other underlying complication. In the remaining 21 (72.4% of PPOI group) cases, it was primary. In 80.9% cases, it resolved completely by five postoperative days. Using univariate regression analysis, we observed that only the female sex (OR 2.71) was an independent predictor of PPOI development, whereas age >65 years was associated with a lower risk (OR 0.33). Also patients after procedures involving handling the small bowel were more likely to develop PPOI (OR 2.65). The remaining demographic and perioperative parameters were not statistically significant. The incidence of PPOI in patients after laparoscopy with ERAS protocol is low and usually resolves within 5 days. However, longer PPOI may indicate underlying complications. Traditional risk factors for PPOI seem to play a limited role in its development.
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References
Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87:1480–1493. doi:10.1046/j.1365-2168.2000.01595.x
Bragg D, El-Sharkawy AM, Psaltis E et al (2015) Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr 34:367–376. doi:10.1016/j.clnu.2015.01.016
Wolthuis AM, Bislenghi G, Fieuws S et al (2016) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Color Dis 18:O1–O9. doi:10.1111/codi.13210
Vather R, Josephson R, Jaung R et al (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157:764–773. doi:10.1016/j.surg.2014.12.005
Gero D, Gié O, Hübner M et al (2016) Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbeck's Arch Surg:1–10. doi:10.1007/s00423-016-1485-1
Iyer S, Saunders WB, Stemkowski S (2009) Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm 15:485–494. doi:10.18553/jmcp.2009.15.6.485
Frager DH, Baer JW, Rothpearl A, Bossart PA (1995) Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings. Am J Roentgenol 164:891–894. doi:10.2214/ajr.164.4.7726042
Levy BF, Scott MJP, Fawcett WJ, Rockall TA (2009) 23-hour-stay laparoscopic colectomy. Dis Colon rectum 52:1239–1243. doi:10.1007/DCR.0b013e3181a0b32d
Delaney CP (2008) Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. Dis Colon rectum 51:181–185. doi:10.1007/s10350-007-9126-y
Lawrence JK, Keller DS, Samia H et al (2013) Discharge within 24 to 72 hours of colorectal surgery is associated with low readmission rates when using enhanced recovery pathways. J Am Coll Surg 216:390–394. doi:10.1016/j.jamcollsurg.2012.12.014
Pędziwiatr M, Pisarska M, Kisielewski M et al (2016) Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery? Med Oncol 33:25–10. doi:10.1007/s12032-016-0738-8
ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg. doi:10.1097/SLA.0000000000001029
Pędziwiatr M, Pisarska M, Major P et al (2016) Laparoscopic colorectal cancer surgery combined with enhanced recovery after surgery protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes. Eur J Surg Oncol 42:779–787. doi:10.1016/j.ejso.2016.03.037
Gordon PH, Nivatvongs S (2007) Principles and practice of surgery for the colon, rectum, and anus, Third edn. CRC Press, USA
Pędziwiatr M, Kisialeuski M, Wierdak M et al (2015) Early implementation of enhanced recovery after surgery (ERAS(®)) protocol - compliance improves outcomes: a prospective cohort study. Int J Surg 21:75–81. doi:10.1016/j.ijsu.2015.06.087
Pisarska M, Pędziwiatr M, Małczak P et al (2016) Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int J Surg 36:377–382. doi:10.1016/j.ijsu.2016.11.088
Moghadamyeghaneh Z, Hwang GS, Hanna MH et al (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609. doi:10.1007/s00464-015-4247-1
Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972. doi:10.1007/s11605-013-2148-y
Chen HH, Wexner SD, Weiss EG et al (2014) Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy. Surg Endosc 12:1397–1400. doi:10.1007/s004649900867
Okholm C, Goetze JP, Svendsen LB, Achiam MP (2014) Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scand J Gastroenterol 49:1027–1034. doi:10.3109/00365521.2014.917698
Wilmore DW (2002) From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 236:643–648. doi:10.1097/01.SLA.0000032942.79841.ED
Durrand JW, Batterham AM, Danjoux GR (2014) Pre-habilitation (i): aggregation of marginal gains. Anaesthesia 69:403–406. doi:10.1111/anae.12666
Kummer A, Slieker J, Grass F et al (2016) Enhanced recovery pathway for right and left colectomy: comparison of functional recovery. World J Surg. doi:10.1007/s00268-016-3563-5
Xu C, Chi P (2014) Relevant factor analysis on postoperative ileus following radical resection for colorectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi 17:361–364
Vignali A, Bissolati M, De Nardi P et al (2016) Extracorporeal vs. Intracorporeal ileocolic stapled anastomoses in laparoscopic right colectomy: an interim analysis of a randomized clinical trial. J Laparoendosc Adv Surg Tech A 26:343–348. doi:10.1089/lap.2015.0547
van Oostendorp S, Elfrink A, Borstlap W et al (2016) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc:1–14. doi:10.1007/s00464-016-4982-y
Chowdhury AH, Lobo DN (2011) Fluids and gastrointestinal function. Curr Opin Clin Nutr Metab Care 14:469–476. doi:10.1097/MCO.0b013e328348c084
Li S, Liu Y, Peng Q et al (2013) Chewing gum reduces postoperative ileus following abdominal surgery: a meta-analysis of 17 randomized controlled trials. J Gastroenterol Hepatol 28:1122–1132. doi:10.1111/jgh.12206
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Pędziwiatr, M., Pisarska, M., Małczak, P. et al. The Incidence of Prolonged Postoperative Ileus After Laparoscopic Colorectal Surgery—Does ERAS Protocol Bring Anything New?. Indian J Surg 80, 333–339 (2018). https://doi.org/10.1007/s12262-017-1602-6
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DOI: https://doi.org/10.1007/s12262-017-1602-6