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Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs—a retrospective analysis of the GRACE database

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

A Correction to this article was published on 08 July 2019

This article has been updated

Abstract

Purpose

Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery.

Methods

This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required.

Results

Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30–6.28), urinary retention (OR = 1.75; 95% CI: 1.05–2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04–9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15–8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74–8.88 and OR = 5.76; 95% CI: 3.56–10.62).

Conclusion

Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.

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Change history

  • 08 July 2019

    When the original article was first published the given name and family names of Francophone Group for Enhanced Recovery After Surgery (GRACE) individually cited within the author list were inadvertently interchanged. The author list are correctly cited in this Correction.

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Funding

Web-hosting of GRACE audit data was funded by the “Caisse National D’Assurance Maladie”.

Author information

Authors and Affiliations

  1. Department of Visceral Surgery, CHU of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Aurélien Venara

  2. UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l’Appareil Digestif, 1, rue Gaston Veil, 44035, Nantes, France

    Aurélien Venara

  3. LUNAM, University of Angers, Angers, France

    Aurélien Venara & Jean-François Hamel

  4. HIFIH Laboratory (UPRES 3859), University of Angers, ULB, 49035, Angers, France

    Aurélien Venara

  5. Department of Anesthesiology, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France

    Pascal Alfonsi

  6. Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, Université de Lyon, 69495, Pierre-Bénite Cedex, France

    Eddy Cotte

  7. Faculty of medicine Lyon-Sud/ Charles Mérieux, 69921, Oullins Cedex, France

    Eddy Cotte

  8. Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France

    Jérôme Loriau

  9. Department of Methodology and Biostatistics, CHU Angers, 49933, Angers Cedex 9, France

    Jean-François Hamel

  10. Department of Visceral Surgery, CHU Clermont-Ferrand, 63003, Clermont Ferrand, France

    Karem Slim

Authors
  1. Aurélien Venara
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  2. Pascal Alfonsi
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  3. Eddy Cotte
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  4. Jérôme Loriau
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  5. Jean-François Hamel
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  6. Karem Slim
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Consortia

for the Francophone Group for Enhanced Recovery After Surgery (GRACE)

  • Abderrazak Mondher
  • , Abolo Hervé
  • , Abras Nicolas
  • , Aissou Mourad
  • , Albertini Serge
  • , Alfonsi Pascal
  • , Andre Adeline
  • , Arimont Jean-Marc
  • , Arnalsteen Laurent
  • , Atger Jerome
  • , Attias Arié
  • , Aumont Ophélie
  • , Auvray Sylvain
  • , Bachmann Radu
  • , Barabino Gabriele
  • , Barsotti Pierre
  • , Beauchesne Brigitte
  • , Beaupel Nathan
  • , Beliard Arnault
  • , Bellouard Arnauld
  • , Beloeil Helene
  • , Ben Salem Faouzi
  • , Benhamou Alexandra
  • , Billard Valerie
  • , Binhas Michèle
  • , Binot Daniel
  • , Blache Jean Louis
  • , Blache Jean-Louis
  • , Blet Alice
  • , Bongiovanni Jean-Pierre
  • , Bonnal Aurélien
  • , Bonnet Marc
  • , Boret Henry
  • , Bossard Anne-Elisabeth
  • , Bothereau Herve
  • , Bouarroudj Noreddine
  • , Bouayed Amine
  • , Bouchard François
  • , Boumadani M’hamed
  • , Bousquet Michel
  • , Bouygues Vianney
  • , Bozio Guillaume
  • , Brek Amine
  • , Cadi Philippe
  • , Caillon Pierre
  • , Camerlo Antoine
  • , Capito Carmen
  • , Cardin Jean Luc
  • , Castiglioni Marie
  • , Catinois Marie-Line
  • , Cattan Pierre
  • , Chambrier Cecile
  • , Chambrier Gérald
  • , Chapuis Olivier
  • , Chauvin Marcel
  • , Chokairi Seddik
  • , Chopin Laly Xavier
  • , Collange Vincent
  • , Cotte Eddy
  • , Cuellar Emmanuel
  • , D’errico Emanuele
  • , Dahmani Souhayl
  • , Danan Marc
  • , De La Fontaine Christophe
  • , De Wailly Pierre
  • , Degauque Cyril
  • , Delacoste Franck
  • , Denet Christine
  • , Denost Quentin
  • , Desaint Paul
  • , Descamps Eric
  • , Desfourneaux Veronique
  • , Desmet Justine
  • , Desolneux Gregoire
  • , Dileon Sylvain
  • , Dolbeau Jean-Baptiste
  • , Douard Richard
  • , Dufour Fanny
  • , Dupont-Bierre Eric
  • , Dupré Aurélien
  • , Entremont Alexandre
  • , Faucheron Jean Luc
  • , Fernoux Philippe
  • , Figuet Stephanie
  • , Finianos Alain
  • , Flamein Renaud
  • , Fletcher Dominique
  • , Fontes Jean Paul
  • , Fourn Erwan
  • , Gergeanu Sebastian
  • , Germain Adeline
  • , Gignoux Benoît
  • , Goater Philippe
  • , Gres Philippe
  • , Grigoroiu Madalina
  • , Grillo Philippe
  • , Guignard Bruno
  • , Guinier David
  • , Guiot Jean Luc
  • , Gutton Christophe
  • , Hadjadj Haider
  • , Hail Kamel
  • , Hausermann Marie-Hélène
  • , Hennequin Sandra
  • , Homsy-Hubert Brigitte
  • , Jambet Sophie
  • , Janecki Therese
  • , Jannier-Guillou Virginie
  • , Jaspart Jérôme
  • , Joly Fabrice
  • , Joris Jean
  • , Journe Frédéric
  • , Kattou Fehmi
  • , Kemoun Gilles
  • , Khalaf Maged
  • , Klack Floriane
  • , Kothonidis Konstantinos
  • , Kurdi Okba
  • , Laforest Anaïs
  • , Lamblin Antoine
  • , Lammens Stephane
  • , Laporte Sylvain
  • , Launay-Savary Marie-Véronique
  • , Le Maho Anne-Laure
  • , Lemée Jean-Michel
  • , Leonard Daniel
  • , Leonard David
  • , Leporrier Julien
  • , Lorin Jean Louis
  • , Magne Eric
  • , Maisonnette Franck
  • , Malherbe Vincent
  • , Manceau Gilles
  • , Mariani Pascale
  • , Massalou Damien
  • , Massard Jean-Loup
  • , Mauvais Francois
  • , Mbuyamba Jean
  • , Mbuyamba Katapile Jean
  • , Mehila Tarek
  • , Meillat Hélène
  • , Mergui Claude
  • , Michaud Philippe
  • , Milou Fabrice
  • , Mirre Frantz
  • , Mor Martinez Caroline
  • , Mouchon Stephanie
  • , Mouilhade Frédéric
  • , Nguyen Yên-Lan
  • , Ostermann Bucher Sandrine
  • , Page Mathieu
  • , Parent Sébastien
  • , Payen Anne-Laurence
  • , Pedicone Roberto
  • , Peluchon Philippe
  • , Pichot-Delahaye Virginie
  • , Piquard Arnaud
  • , Pirlet Isabelle
  • , Plard Laurent
  • , Poiblanc Marie
  • , Poinas Grégoire
  • , Poincenot Jane
  • , Ponchel Christine
  • , Pontallier Arnaud
  • , Pop Regis
  • , Potiron Eric
  • , Proske Jan Martin
  • , Prunet Bertrand
  • , Ras Emmanuelle
  • , Raspado Olivier
  • , Raux Mathieu
  • , Regimbeau Jean-Marc
  • , Remue Christophe
  • , Renacco Frédéric
  • , Riboud Romain
  • , Richard-Payen Anne-Laurence
  • , Rio Didier
  • , Sage Michel
  • , Sage Pierre Yves
  • , Saint Denis Marc
  • , Salaun Pascale
  • , Samyn Brice
  • , Sbai Idrissi Mohamed
  • , Schmitt Ghislain
  • , Secq Edouard
  • , Seddiki Ahmed
  • , Sens Nicolas
  • , Sirieix Didier
  • , Siriser Franck
  • , Siriser Frank
  • , Slim Karem
  • , Tarcea Mihai
  • , Tavernier Marion
  • , Tete Bernard
  • , Theissen-Laval Odile
  • , Thevenot Alice
  • , Thievenaz Rémy
  • , Vacher Bernard
  • , Venara Aurelien
  • , Verhaeghe Romain
  • , Verrier JF
  • , Vieuille Christine
  • , Voilin Christian
  • , Vuagnat Christian
  •  & Zaepfel Sophie

Contributions

Aurélien Venara and Karem Slim made substantial contributions to the conception and design of this work, acquisition, and interpretation of data and drafted the manuscript. They gave their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

Pascal Alfonsi, Eddy Cotte, and Jérôme Loriau made substantial contributions to the acquisition and interpretation of data and critically revised the manuscript, as well as giving their final approval of the version to be published and their agreement to be held accountable for all aspects of the work.

Jean François Hamel made substantial contributions to the interpretation and analysis of data and drafted the manuscript, as well as giving his final approval of the version to be published and his agreement to be held accountable for all aspects of the work.

Corresponding author

Correspondence to Aurélien Venara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

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Appendix

Appendix

GRACE Association Study Group/Participating Investigators personally cared for study patients

Name

Surname

Affiliation

City

Country

Abderrazak

Mondher

CLINIQUE SAINT GERMAIN

BRIVE

France

Abolo

Hervé

Clinique des Ormeaux

Le Havre

France

Abras

Nicolas

Hopital du gier

Saint Chamond

France

Aissou

Mourad

champigny sur marne

champigny sur marne

France

Albertini

Serge

clinique des cedres

echirolles

France

Alfonsi

Pascal

Hôpital Saint Joseph

Paris

France

Andre

Adeline

Hopital privé de la Loire

Saint Etienne

France

Arimont

Jean-marc

CH-ALPES LEMAN

contamine sur arve

France

Arnalsteen

Laurent

Hôpital Privé La louvière

Lille

France

Atger

Jerome

CHICAS GAP

Gap

France

Attias

Arié

Henri Mondor

CRETEIL

France

Aumont

Ophélie

Centre Léon Bérard

lyon

France

Auvray

Sylvain

Hopital Privé Saint-Martin

caen

France

Bachmann

Radu

Cliniques universitaires Saint-Luc

Bruxelles

Belgique

Barabino

Gabriele

CHU Saint Etienne

Saint Priest en Jarez

France

Barsotti

Pierre

hopital emile muller

Mulhouse

France

Beauchesne

Brigitte

hopital nord

saint priest en jarez

France

Beaupel

Nathan

Hopital Saint-Louis

paris

France

Beliard

Arnault

Clinique Saint Jean Languedoc

Toulouse

France

Bellouard

Arnauld

Clinique de l'Archette

OLIVET

France

Beloeil

Helene

chu pontchaillou

rennes

France

Ben Salem

Faouzi

Ben Salem

Monastir

Tunisie

Benhamou

Alexandra

Clinique du Cèdre

Bois Guillaume

France

Billard

Valerie

Gustave Roussy

Villejuif

France

Binhas

Michèle

Centre hospitalier de Marne La Vallée

Jossigny

France

Binot

Daniel

Centre MCO Côte d'Opale

BOULOGNE SUR MER CEDEX

France

Blache

Jean Louis

INSTITUT PAOLI CALMETTES

MARSEILLE

France

Blache

Jean-Louis

INSTITUT PAOLI CALMETTES

MARSEILLE

France

Blet

Alice

Hopital Saint-Louis

paris

France

Bongiovanni

Jean-pierre

Centre Hospitalier Saint Josephsaint luc

Lyon

France

Bonnal

Aurélien

Clinique Saint Jean

Montpellier

France

Bonnet

Marc

HOPITAL EUROPEEN

MARSEILLE

France

Boret

Henry

CHITS

Toulon

France

Bossard

Anne-elisabeth

Institut Mutualiste Montsouris

Paris

France

Bothereau

Herve

Centre Hospitalier Privé Saint-Grégoire

SAINT-GREGOIRE

France

Bouarroudj

Noreddine

CLINIQUE NAOUFEL

CONSTANTINE

Algerie

Bouayed

Amine

centre hospitalier de Salon de Provence

salon de provence

France

Bouchard

François

clinique des cedres

echirolles

France

Boumadani

M'hamed

clinique saint francois

mainvilliers

France

Bousquet

Michel

CENTRE HOSPITALIER PRIVE DE L'EUROPE

Le Port Marly

France

Bouygues

Vianney

Hôpital Yves le Foll

Saint Brieuc

France

Bozio

Guillaume

Medipole de Savoie

Challes-les-Eaux

France

Brek

Amine

hopital nord

saint priest en jarez

France

Cadi

Philippe

HOPITAL PRIVE DE L'OUEST PARISIEN

TRAPPES

France

Caillon

Pierre

clinique du tonkin

villeurbanne

France

Camerlo

Antoine

HOPITAL EUROPEEN

MARSEILLE

France

Capito

Carmen

Necker-Enfants Malades

Paris

France

Cardin

Jean luc

Polyclinique du Maine

LAVAL

France

Castiglioni

Marie

polyclinique poitiers

poitiers

France

Catinois

Marie-line

Clinique d'ARGONAY

ARGONAY

France

Cattan

Pierre

Hopital Saint-Louis

paris

France

Chambrier

Cecile

Hopital de la Croix Rousse

Lyon

France

Chambrier

Gérald

CLINIQUE TRENEL

SAINTE COLOMBE

France

Chapuis

Olivier

Clinique du Val d'Or

SAINT CLOUD

France

Chauvin

Marcel

Hôpital Ambroise Paré

Boulogne Billancourt

France

Chokairi

Seddik

Centre Hospitalier

USSEL

France

Chopin Laly

Xavier

Clinique Charcot

Sainte Foy Les Lyon

France

Collange

Vincent

CLINIQUE DU GRAND LARGE

Décines

France

Cotte

Eddy

Centre Hospitalier Lyon-Sud

Pierre-Bénite

France

Cuellar

Emmanuel

CHU Toulouse

TOULOUSE

France

D'errico

Emanuele

Polyclinique Grand Sud

NIMES

France

Dahmani

Souhayl

Hôpital Robert Debré

Paris

France

Danan

Marc

Clinique Saint-Michel

toulon

France

De La Fontaine

Christophe

Clinique de l'Archette

OLIVET

France

De Wailly

Pierre

Polyclinique Keraudren

BREST

France

Degauque

Cyril

CHR VERVIERS

VERVIERS

Belgique

Delacoste

Franck

CHICAS GAP

Gap

France

Denet

Christine

Institut Mutualiste Montsouris

Paris

France

Denost

Quentin

CMC Magellan

Pessac

France

Desaint

Paul

CHU cochin port royal

paris

France

Descamps

Eric

HOPITAL PRIVE DE L'EST PARISIEN

AULNAY SOUS BOIS

France

Desfourneaux

Veronique

chu pontchaillou

rennes

France

Desmet

Justine

Cliniques universitaires Saint-Luc

Bruxelles

Belgique

Desolneux

Gregoire

Institut Bergonié

Bordeaux

France

Dileon

Sylvain

Clinique Saint Roch

Cavaillon

France

Dolbeau

Jean-baptiste

Polyclinique Bordeaux Rive Droite

Lormont

France

Douard

Richard

Hôpital européen Georges Pompidou

Paris

France

Dufour

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Centre Hospitalier Marne La VAllee

Jossigny

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Centre Hospitalier Privé Saint-Grégoire

SAINT-GREGOIRE

France

Dupré

Aurélien

Centre Léon Bérard

lyon

France

Entremont

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Hôpital D’Estaing

Clermont-Ferrand

France

Faucheron

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CHU Grenoble Alpes

La Tronche

France

Fernoux

Philippe

Hôpital privé Sainte marie

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France

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clinique du MILLENAIRE

montpellier

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polyclinique du sidobre

Castres

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France

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Clinique de la Sauvegarde

Lyon

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Institut Curie

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France

Gres

Philippe

Centre Hospitalier d'Alès-en-Cévennes

ALES Cedex

France

Grigoroiu

Madalina

Institut Mutualiste Montsouris

Paris

France

Grillo

Philippe

CLINIQUE JUGE

MARSEILLE

France

Guignard

Bruno

Clinique du Val d'Or

SAINT CLOUD

France

Guinier

David

Centre Hospitalier Bretagne Sud

Lorient

France

Guiot

Jean luc

Pole de Santé du Plateau

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France

Gutton

Christophe

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Paris

France

Hadjadj

Haider

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Kamel

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Alger

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Aurillac

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cahors

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Paris

France

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Toulon

France

Janecki

Therese

Centre Hospitalier de Roubaix

Roubaix

France

Jannier-guillou

Virginie

Clinique Sainte Clotilde

Sainte clotilde

Reunion

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Jérôme

Boulogne sur mer

Boulogne-sur-Mer

France

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Toulon

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Joris

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Liège

Belgique

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clinique st coeur

Vendôme

France

Kattou

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Institut Mutualiste Montsouris

Paris

France

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PARIS

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Khalaf

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Belley

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TOULON

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Angers

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Leonard

Daniel

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Bruxelles

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David

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saumur

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caen

France

Lorin

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France

Massalou

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Nice

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Massard

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Mauvais

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Beauvais

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Mbuyamba

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arras

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Mbuyamba Katapile

Jean

centre hospitalier d'Arras

arras

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Mehila

Tarek

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Meillat

Hélène

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Mergui

Claude

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voiron

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Michaud

Philippe

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OLIVET

France

Milou

Fabrice

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LYON

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Mirre

Frantz

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saint paul

Reunion

Mor Martinez

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clinique de l'alliance

saint cyr / loire

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Mouchon

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clinique de l'alliance

saint cyr / loire

France

Mouilhade

Frédéric

clinique de l'europe

Rouen

France

Nguyen

Yên-lan

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paris

France

Ostermann Bucher

Sandrine

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GENEVE

Suisse

Page

Mathieu

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Bourg-en-Bresse

France

Parent

Sébastien

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Décines

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Payen

Anne-Laurence

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Roberto

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Coulommiers

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Philippe

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Arnaud

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Orleans

France

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Isabelle

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Plard

Laurent

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Avranches

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Poiblanc

Marie

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lyon

France

Poinas

Grégoire

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Poincenot

Jane

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creteil

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Christine

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Arnaud

Magellan Haut-Lévèque

Pessac

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Pop

Regis

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Potiron

Eric

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Proske

Jan martin

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Bertrand

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Ras

Emmanuelle

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Roubaix

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Raspado

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Raux

Mathieu

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paris

France

Regimbeau

Jean-marc

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Amiens

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Remue

Christophe

Cliniques universitaires Saint-Luc

Bruxelles

Belgique

Renacco

Frédéric

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Ollioules

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Riboud

Romain

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Richard-Payen

Anne-Laurence

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France

Rio

Didier

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Vannes

France

Sage

Michel

polyclinique mutualiste sainte marguerit

Auxerre

France

Sage

Pierre yves

CHU Grenoble Alpes

La Tronche

France

Saint denis

Marc

Hopital privé d'antony

antony

France

Salaun

Pascale

Le Confluent-NouvellesCliniquesNantaises

NANTES

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Samyn

Brice

Clinique de l'Orangerie

Strasbourg

France

Sbai Idrissi

Mohamed

Hopital Simone VEIL

Eaubonne

France

Schmitt

Ghislain

Polyclinique de Courlancy

REIMS

France

Secq

Edouard

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Saint Quentin

France

Seddiki

Ahmed

CHU Oran

Oran

Algerie

Sens

Nicolas

Centre Léon Bérard

lyon

France

Sirieix

Didier

Hopital privé d'antony

antony

France

Siriser

Franck

Hopital Privé Saint-Martin

caen

France

Siriser

Frank

Hopital Privé Saint-Martin

caen

France

Slim

Karem

Hôpital D’Estaing

Clermont-Ferrand

France

Tarcea

Mihai

Clinique des Ormeaux

Le Havre

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Tavernier

Marion

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Tete

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France

Theissen-Laval

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Mulhouse

France

Thevenot

Alice

Hopital Saint-Louis

paris

France

Thievenaz

Rémy

Clinique Charcot

Sainte Foy Les Lyon

France

Vacher

Bernard

Centre Hospitalier Victor Dupouy

argenteuil

France

Venara

Aurelien

CHU Angers

Angers Cedex 9

France

Verhaeghe

Romain

Centre MCO Côte d'Opale

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France

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Lyon

France

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clinique de la cote d'emeraude

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France

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Polyclinique du cotentin

EQUEURDREVILLE-HAINNEVILLE

France

Zaepfel

Sophie

Hôpital européen Georges Pompidou

Paris

France

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Venara, A., Alfonsi, P., Cotte, E. et al. Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs—a retrospective analysis of the GRACE database. Int J Colorectal Dis 34, 71–83 (2019). https://doi.org/10.1007/s00384-018-3165-9

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