Skip to main content

Advertisement

SpringerLink
Log in

A global survey of surgeons’ preferences and practice with regard to laxative use after elective colorectal surgery

  • Short Communication
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The role of laxatives after elective colorectal surgery is unclear, resulting in heterogenous guidelines and variability in clinical practice. This study aimed to gauge surgeons’ preferences and practice with regard to laxative use following elective colorectal surgery.

Methods

A short one-minute anonymous web-based questionnaire designed in English and Chinese (Mandarin) using the Research Electronic Data Capture application (REDCap) was distributed to member surgeons of every identifiable international colorectal specialist society via email communication, physical newsletters and social media channels. Frequency of laxative use after elective colorectal surgery, type of laxative used, and, if not used, the reasons for not using laxatives were collected.

Results

A total of 852 surgeons, representing 28 surgical societies completed the survey: 80% were colorectal surgeons and 20% were general surgeons with colorectal interest. Twenty-seven percent of the respondents routinely prescribed laxatives after colorectal surgery. There was wide variation in the type of laxatives used, with magnesium-based laxatives (42%), macrogol (Movicol, 36%) and lactulose (Duphalac, 22%) being the most common. Geographical location was correlated with choice of laxative. Those not routinely using laxatives stated the reasons as being no evidence for benefit (48%), potential of adverse events (24%), more than one reason (21%) and other (7%). The majority (93%) non-users would consider using laxatives if better evidence was available.

Conclusion

Most surgeons do not routinely prescribe laxatives after elective colorectal surgery due to lack of evidence. Amongst those surgeons who do use them, there is wide variability in the type of laxatives used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Okamoto A, Kohama K, Aoyama-Ishikawa M, Yamashita H, Fujisaki N, Yamada T, Yumoto T, Nosaka N, Naito H, Tsukahara K, Iida A, Sato K, Kotani J, Nakao A (2016) Intraperitoneally administered, hydrogen-rich physiologic solution protects against postoperative ileus and is associated with reduced nitric oxide production. Surgery 160(3):623–631. https://doi.org/10.1016/j.surg.2016.05.026

    Article  PubMed  Google Scholar 

  2. Scarborough JE, Schumacher J, Kent KC, Heise CP, Greenberg CC (2017) Associations of specific postoperative complications with outcomes after elective colon resection: a procedure-targeted approach toward surgical quality improvement. JAMA Surg 152(2):e164681. https://doi.org/10.1001/jamasurg.2016.4681

    Article  PubMed  Google Scholar 

  3. Goldstein J, Matuszewski K, Delaney C, Senagore A, Chiao E, Shah M, Meyer K, Bramley T (2007) Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States. P T 32(2):82–90

    Google Scholar 

  4. Dudi-Venkata NN, Kroon HM, Bedrikovetski S, Moore JW, Sammour T (2019) Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery. ANZ J Surg. https://doi.org/10.1111/ans.15319

  5. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg 43(3):659–695. https://doi.org/10.1007/s00268-018-4844-y

    Article  CAS  Google Scholar 

  6. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  7. Zingg U, Miskovic D, Pasternak I, Meyer P, Hamel CT, Metzger U (2008) Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial. Int J Color Dis 23(12):1175–1183. https://doi.org/10.1007/s00384-008-0536-7

    Article  CAS  Google Scholar 

  8. Andersen J, Christensen H, Pachler JH, Hallin M, Thaysen HV, Kehlet H (2012) Effect of the laxative magnesium oxide on gastrointestinal functional recovery in fast-track colonic resection: a double-blind, placebo-controlled randomized study. Color Dis 14(6):776–782. https://doi.org/10.1111/j.1463-1318.2011.02796.x

    Article  CAS  Google Scholar 

  9. Crebbin W, Beasley SW, Watters DA (2013) Clinical decision making: how surgeons do it. ANZ J Surg 83(6):422–428. https://doi.org/10.1111/ans.12180

    Article  PubMed  Google Scholar 

  10. Flin R, Youngson G, Yule S (2007) How do surgeons make intraoperative decisions? Qual Saf Health Care 16(3):235–239. https://doi.org/10.1136/qshc.2006.020743

    Article  PubMed  PubMed Central  Google Scholar 

  11. Clavien PA, Dindo D (2007) Surgeon’s intuition: is it enough to assess patients’ surgical risk? World J Surg 31(10):1909–1911. https://doi.org/10.1007/s00268-007-9145-9

    Article  PubMed  Google Scholar 

  12. Basse L, Madsen JL, Kehlet H (2001) Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative. Br J Surg 88(11):1498–1500. https://doi.org/10.1046/j.0007-1323.2001.01916.x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Mr. Gianluca Pellino (Y-SICCR) and to the Italian Society of Colorectal Surgery SICCR for sending the survey across their society members.

Funding

This research is supported by RACS WG Norman Research Scholarship (RACS ID 187648) and Medtronic (Australia) Colorectal Research Fellowship Supplementary Scholarship (a1753714).

Author information

Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia

    Nagendra N. Dudi-Venkata, Hidde M. Kroon, James W. Moore, Michelle L. Thomas & Tarik Sammour

  2. Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia

    Nagendra N. Dudi-Venkata, Sergei Bedrikovetski, James W. Moore, Michelle L. Thomas & Tarik Sammour

Authors
  1. Nagendra N. Dudi-Venkata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidde M. Kroon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergei Bedrikovetski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James W. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle L. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tarik Sammour
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nagendra N. Dudi-Venkata.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dudi-Venkata, N.N., Kroon, H.M., Bedrikovetski, S. et al. A global survey of surgeons’ preferences and practice with regard to laxative use after elective colorectal surgery. Int J Colorectal Dis 35, 759–763 (2020). https://doi.org/10.1007/s00384-020-03521-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-020-03521-1

Keywords

Search

Navigation