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2.
Int J Mol Sci ; 23(13)2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35805922

RESUMO

Feeding intolerance and the development of ileus is a common complication affecting critically ill, surgical, and trauma patients, resulting in prolonged intensive care unit and hospital stays, increased infectious complications, a higher rate of hospital readmission, and higher medical care costs. Medical treatment for ileus is ineffective and many of the available prokinetic drugs have serious side effects that limit their use. Despite the large number of patients affected and the consequences of ileus, little progress has been made in identifying new drug targets for the treatment of ileus. Inflammatory mediators play a critical role in the development of ileus, but surprisingly little is known about the direct effects of inflammatory mediators on cells of the gastrointestinal tract, and many of the studies are conflicting. Understanding the effects of inflammatory cytokines/chemokines on the development of ileus will facilitate the early identification of patients who will develop ileus and the identification of new drug targets to treat ileus. Thus, herein, we review the published literature concerning the effects of inflammatory mediators on gastrointestinal motility.


Assuntos
Gastroenteropatias , Íleus , Estado Terminal , Gastroenteropatias/complicações , Motilidade Gastrointestinal , Humanos , Íleus/etiologia , Recém-Nascido , Mediadores da Inflamação/farmacologia , Complicações Pós-Operatórias/etiologia
3.
PLoS One ; 17(7): e0271580, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35849611

RESUMO

BACKGROUND: Postoperative ileus (POI) is an important complication of gastrointestinal (GI) surgery. Acupuncture has been increasingly used in treating POI. This study aimed to assess the effectiveness and safety of acupuncture for POI following GI surgery. METHODS: Seven databases (PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wan fang Data, VIP Database for Chinese Technical Periodicals, and Chinese Biomedical Literature Database) and related resources were searched from inception to May 30, 2021. Randomized controlled trials (RCTs) reporting the acupuncture for POI in GI were included. The quality of RCTs was assessed by the Cochrane Collaboration Risk of Bias tool, and the certainty of the evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. A meta-analysis was performed by using RevMan 5.4 software. RESULTS: Eighteen RCTs involving 1413 participants were included. The meta-analysis showed that acupuncture could reduce the time to first flatus (TFF) (standardized mean difference [SMD] = -1.14, 95% confidence interval [CI]: -1.54 to -0.73, P < 0.00001), time to first defecation (TFD) (SMD = -1.31, 95% CI: -1.88 to -0.74, P < 0.00001), time to bowel sounds recovery (TBSR) (SMD = -1.57, 95% CI: -2.14 to -1.01, P < 0.00001), and length of hospital stay (LOS) (mean difference [MD] = -1.68, 95% CI: -2.55 to -0.80, P = 0.0002) compared with usual care. A subgroup analysis found that acupuncture at distal acupoints once daily after surgery had superior effects on reducing TFF and TFD. A sensitivity analysis supported the validity of the finding. Acupuncture also manifested an effect of reducing TFF, TFD and TBSR compared with sham acupuncture but the result was not stable. Relatively few trials have reported whether adverse events have occurred. CONCLUSIONS: Acupuncture showed a certain effect in reducing POI following GI surgery with very low-to-moderate quality of evidence. The overall safety of acupuncture should be further validated. More high-quality, large-scale, and multicenter original trials are needed in the future.


Assuntos
Terapia por Acupuntura , Procedimentos Cirúrgicos do Sistema Digestório , Íleus , Pontos de Acupuntura , Terapia por Acupuntura/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Íleus/etiologia , Íleus/terapia , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
4.
J Investig Med High Impact Case Rep ; 10: 23247096221109206, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35762500

RESUMO

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited disease, predominantly seen in female patients, caused by mutations in the hydroxymethylbilane synthase gene. When impaired, elevated heme biosynthesis precursor levels accumulate in the liver, resulting in neurological symptoms, psychiatric disturbances, darkened urine color, abdominal pain, nausea, vomiting, and ileus. We present a 22-year-old Hispanic female with diffuse abdominal pain and no bowel movements for 8 days. She reported recent antibiotic and oral contraceptive pill use. Computerized tomography of her abdomen revealed a dilated small bowel and marked colonic distension. A colonoscopy found mild nonspecific inflammation in the rectosigmoid and terminal ileum. Her abdominal pain persisted despite interventions and improvements in appetite, bowel movements, abdominal imaging, and treatment of an identified Clostridium difficile infection. A random urine porphobilinogen was then obtained and found to be elevated. Fractionation of plasma and urine porphyrins was suggestive of AIP. Her symptoms improved with 3 days of intravenous (IV) hematin and IV dextrose. This is a unique case of a rare disease due to her clinical presentation with ileus, unremarkable past medical history, family history, and the prehospitalization and intrahospitalization factors that likely exacerbated the patient AIP.


Assuntos
Íleus , Porfiria Aguda Intermitente , Dor Abdominal/etiologia , Feminino , Humanos , Hidroximetilbilano Sintase/genética , Mutação , Porfiria Aguda Intermitente/complicações , Porfiria Aguda Intermitente/diagnóstico , Porfiria Aguda Intermitente/genética , Adulto Jovem
7.
Comput Intell Neurosci ; 2022: 9747880, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35726291

RESUMO

Objective: To explore the application of somatostatin combined with nasal plug catheterization in patients with advanced gastric cancer and acute intestinal obstruction. Methods. This study included 94 cases of patients with acute intestinal obstruction and advanced gastric cancer, and according to the length of hospital stay, the patients were randomly divided into two groups: the control group and the study group, with 47 cases in each group. Based on the observations made by the team in the control group given somatostatin combined treatment, we observed two groups of patients with gastrointestinal function, serum index, quality of life, therapeutic effect, and adverse reactions. Results. Abdominal distention, abdominal pain duration, and normal exhaust time were significantly shorter in the study group than in the control group. The study group was higher than the control group in terms of gastrointestinal decompression volume, drainage volume, and abdominal circumference reduction within 24 hours (P < 0.05). After treatment, the levels of CRP, IgA, LPS, and FABP were lower than before, and the levels of CRP, IgA, LPS, and FABP in the former group were much lower than those in the latter group (P < 0.05). Compared with before treatment, the former GIQLI scale score was significantly higher than the latter (P < 0.05). After treatment, the efficiency is much higher than the latter (P < 0.05). After treatment, the former significantly lowers the incidence of postoperative complications of the latter (P < 0.05). Conclusion. For patients with advanced gastric cancer and acute intestinal obstruction, it is safe and feasible to use somatostatin combined with transnasal intestinal obstruction catheterization to restore gastrointestinal function, improve inflammatory response, and promote the improvement of quality of life with high safety and feasibility.


Assuntos
Íleus , Obstrução Intestinal , Neoplasias Gástricas , Cateterismo , Humanos , Íleus/complicações , Íleus/terapia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/terapia , Qualidade de Vida , Somatostatina/uso terapêutico , Neoplasias Gástricas/complicações , Neoplasias Gástricas/terapia
8.
Nihon Shokakibyo Gakkai Zasshi ; 119(6): 566-572, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35691927

RESUMO

A 55-year-old man presented with vomiting and upper abdominal pain. Two months later, computed tomography revealed jejunal wall thickening and contrast enhancement. Double-balloon endoscopy revealed severe jejunal stenosis and mucosal prolapse. The patient was diagnosed with stenotic ischemic small bowel inflammation and underwent partial small bowel resection. Clinicians should consider intraperitoneal band formation in the differential diagnosis of patients without a history of abdominal surgery or trauma. Surgical resection should be considered to prevent strangulation ileus.


Assuntos
Enterite , Íleus , Obstrução Intestinal , Constrição Patológica , Enterite/diagnóstico por imagem , Enterite/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Jejuno , Masculino , Pessoa de Meia-Idade
9.
J Opioid Manag ; 18(3): 281-286, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35666485

RESUMO

OBJECTIVE: To examine the role of Targin® (oral oxycodone:naloxone combination) in the perioperative setting. DESIGN: A single center prospective observational pilot study at a regional hospital. SETTING: Thirty-eight eligible patients undergoing major general surgical operations were recruited. Thirty-two patients completed the study. INTERVENTIONS: Participants were given Targin twice daily from day 2 post-operatively with twice daily measures of pain scores, gut function, and mobility. MAIN OUTCOME MEASURES: The primary end points were analgesic efficacy and the rate of ileus. Secondary end points were gastrointestinal (GI) recovery and the need for opioid requirement on discharge, at 1 week and 1 month. RESULTS: Average pain score over 5 days at rest was one and on movement was four out of 10. All patients mobilized to a chair by day 3. Twenty-six participants (81.3 percent) experienced nausea at some point during the study, and four participants (12.5 percent) were diagnosed with a post-operative ileus (POI). There was no serious adverse event reported. Only two patients were on opioids at 1-month discharge. This was due to them having Orthopaedic surgery not related to this study.


Assuntos
Analgesia , Íleus , Alcaloides Opiáceos , Analgésicos Opioides/efeitos adversos , Humanos , Íleus/induzido quimicamente , Antagonistas de Entorpecentes , Oxicodona/efeitos adversos , Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos
10.
BMC Surg ; 22(1): 183, 2022 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-35568851

RESUMO

BACKGROUND: Previous studies reported that transnasal ileus tube was a new and useful method for rapid relief of small intestinal obstruction. However, no study reported the impacts of the transnasal ileus tube for Crohn's disease combined with intestinal obstruction. We aimed to describe the strategy to the small intestine obstruction caused by Crohn's disease on the basis of transnasal ileus tube insertion. METHODS: From November 2019 to November 2021, the data of 6 hospitalized patients with CD, diagnosed and conservatively treated in The Second Hospital of Nanjing, were not relived and retrospectively collected. After the insertion of transnasal ileus tube, demographic information, clinical features and treatment data were extracted from medical records. RESULTS: Six Crohn's disease patients with intestinal obstruction were included. Half of them were male. The patients aged from 29 to 70 years. Five patients had chronic intestinal obstruction more than one year. Three patients had intestinal surgery history. One patient had colonic abdominal fistula and anastomotic fistula, when she took intermittent usage of sulfsalazine and steroid. On admission, all the patients had abdominal pain, distention and mass. Five patients had anemia, low albumin and cholinesterase. All CDAI scores were more than 400. Compared to 19 patients with incomplete intestinal obstruction improved by nasogastric decompression tube, 6 patients with intestinal obstruction catheter had significant difference in time for relieving abdominal pain and distension (p = 0.003), time for alleviating abnormal mass (p ≤ 0.01), drainage volume (p = 0.004), and preoperative CDAI score (p = 0.001). Compared with X-ray image before insertion, complete remission of obstruction of 5 patients were observed in intestinal cavity after insertion. After 1-2 months nutrition, all the patients had small intestine resection and ileostomy, half of them underwent colectomy and fistula repair, and 4 patients were performed enterolysis at the same time, the residual small intestine length ranging from 250 to 400 cm. 1 patient had permanent ileostomy;1 patient had abdominal infection after operation. The typical manifestations of acute and chronic inflammation, transmural inflammation, pseudopolyps and serous fiber hyperplasia could be seen in pathological findings of patients 1 to 5. All the patients continued enteral nutrition after surgery. Four patients were treated with infliximab or vedolizumab. CONCLUSION: The current intestinal obstruction catheter which is used to treat patients with Crohn's combined obstruction can afford quick clinical remission, longer nutrition time, and suitable preoperative CDAI score for operation, which is worthy of wildly being used.


Assuntos
Doença de Crohn , Íleus , Obstrução Intestinal , Dor Abdominal , Doença de Crohn/complicações , Feminino , Humanos , Inflamação , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Masculino , Estudos Retrospectivos
11.
Tech Coloproctol ; 26(8): 645-653, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35596903

RESUMO

BACKGROUND: The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS: Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS: A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS: PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.


Assuntos
Íleus , Neoplasias Retais , Idoso , Feminino , Humanos , Ileostomia/efeitos adversos , Íleus/etiologia , Íleus/prevenção & controle , Masculino , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Neoplasias Retais/cirurgia , Fatores de Risco
12.
Oncologist ; 27(7): 532-e542, 2022 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-35641232

RESUMO

BACKGROUND: We conducted an investigator-initiated, phase I trial of vincristine sulfate liposomal injection (VSLI) in combination with bendamustine and rituximab (BR) for indolent B-cell (BCL) or mantle cell lymphoma. METHODS: Participants received 6 cycles of standard BR with VSLI at patient-specific dose determined by the Escalation with Overdose Control (EWOC) model targeting 33% probability of dose-limiting toxicity (DLT). Maximum tolerated dose (MTD) was the primary endpoint; secondary endpoints included rates of adverse events (AEs), overall response rate (ORR), and complete response (CR). Vincristine sulfate liposomal injection is FDA approved for the treatment of patients with recurrent Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL). RESULTS: Among 10 enrolled patients, VSLI was escalated from 1.80 to 2.24 mg/m2, with one DLT (ileus) at 2.04 mg/m2. Two patients discontinued VSLI early. The most common AE included lymphopenia (100%), constipation, nausea, infusion reaction (each 60%), neutropenia, and peripheral neuropathy (50%). Grade 3/4 AE included lymphopenia (90%), neutropenia (20%), and ileus (10%), with prolonged grade ≥2 lymphopenia observed in most patients. Calculated MTD for VSLI was 2.25 mg/m2 (95% Bayesian credible interval: 2.00-2.40). Overall response was 100% with 50% CR. With median follow-up 26 months, 4/10 patients experienced recurrence and 1 died. CONCLUSION: Vincristine sulfate liposomal injection at 2.25 mg/m2 can be safely combined with BR for indolent B-cell lymphoma, but given observed toxicities and recurrences, we did not pursue an expanded cohort.Clinical Trials Registration Number: ClinicalTrials.gov identifier NCT02257242.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Linfoma de Células B , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Teorema de Bayes , Cloridrato de Bendamustina/uso terapêutico , Humanos , Íleus/induzido quimicamente , Lipossomos , Linfoma de Células B/tratamento farmacológico , Linfopenia , Neutropenia/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
13.
Open Vet J ; 12(2): 281-289, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35603070

RESUMO

Background: The horizontal beam (HB) view has been used in the identification of pneumothorax, pleural effusion, and pneumoperitoneum in small animals. Based on the literature, there were no published data evaluating the utility of HB radiography in vomiting dogs to differentiate between patients with or without mechanical gastrointestinal ileus. Aim: The purpose of this prospective pilot study was to determine the utility of HB radiograph as an additional view in vomiting dogs to differentiate patients with or without mechanical gastrointestinal ileus; and describe if there are any radiographic image characteristics associated with the HB view for patients with mechanical gastrointestinal ileus. Methods: A prospective study was carried out on dogs presented with acute vomiting. For all dogs, four radiographic views [ventrodorsal (VD), right lateral, left lateral, and left-to-right lateral HB in sternal recumbency] of the abdomen and abdominal ultrasound were obtained. If a mechanical ileus was detected ultrasonographically, an exploratory laparotomy or endoscopy was performed, otherwise medical treatment was elected. Results: A total of 22 patients were recruited, 11 diagnosed with mechanical ileus and 11 without mechanical ileus. Three blinded reviewers independently assessed the radiographs in three sets: vertical beam (VB) views, HB view alone, and a combination of both views. No statistical difference was found in the differentiation between patients with or without mechanical gastrointestinal ileus between HB views alone or added to VB views. Conclusion: This study suggests that the HB view in sternal recumbency may be an alternative for patients who are not stable enough to be positioned in lateral or VD recumbency.


Assuntos
Doenças do Cão , Íleus , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Íleus/diagnóstico por imagem , Íleus/veterinária , Projetos Piloto , Estudos Prospectivos , Radiografia , Vômito/diagnóstico por imagem , Vômito/veterinária
14.
Surgery ; 172(2): 506-511, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35513905

RESUMO

BACKGROUND: Frailty has been associated with greater postoperative morbidity and mortality but its impact has not been investigated in patients with diverticulitis undergoing elective colon resection. Therefore, the present study examined the association of frailty with perioperative outcomes following elective colectomy for diverticular disease. METHODS: The 2017-2019 American College of Surgeons-National Surgical Quality Improvement Program data registry was queried to identify patients (aged ≥18 years) undergoing elective colon resection for diverticular disease. The 5-factor modified frailty index (mFI-5) was used to stratify patients into non-frail (mFI 0), prefrail (mFI 1), and frail (mFI ≥2) cohorts. Major adverse events, surgical site infection, and postoperative ileus as well as prolonged length of stay, nonhome discharge, and unplanned readmission were evaluated using multivariable logistic models. RESULTS: Of the 20,966 patients, 10.0% were frail. Compared to others, frail patients were generally older (non-frail: 55 years, [46-63], prefrail: 62, [54-70], frail: 64, [57-71]) and more commonly female (non-frail: 53.1%, prefrail: 58.6, frail: 64.4, P < .001). Frail patients more frequently underwent open colectomy and stoma creation compared with others. Frailty was associated with greater adjusted odds of major adverse event (adjusted odds ratio 1.25, 95% confidence interval 1.06-1.48), surgical site infection (adjusted odds ratio 1.28, 95% confidence interval 1.06-1.54), and postoperative ileus (adjusted odds ratio 1.59, 95% confidence interval 1.27-1.98). Similarly, frailty portended greater odds of prolonged length of stay, nonhome discharge, and unplanned readmission. CONCLUSION: Frailty as defined by the mFI-5 was associated with greater morbidity and hospital resource use. Deployment of frailty instruments may augment traditional risk calculators and improve patient selection for elective colectomy.


Assuntos
Doenças Diverticulares , Fragilidade , Íleus , Adolescente , Adulto , Colectomia/efeitos adversos , Colo , Doenças Diverticulares/complicações , Feminino , Fragilidade/complicações , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Íleus/epidemiologia , Íleus/etiologia , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica
15.
Br J Surg ; 109(8): 704-710, 2022 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-35639621

RESUMO

BACKGROUND: Delayed return to gut function and prolonged postoperative ileus (PPOI) delay recovery after colorectal surgery. Prucalopride is a selective serotonin-4-receptor agonist that may improve gut motility. METHODS: This was a multicentre, double-blind, parallel, placebo-controlled randomized trial of 2 mg prucalopride versus placebo in patients undergoing elective colorectal resection. Patients with inflammatory bowel disease and planned ileostomy formation were excluded, but colostomy formation was allowed. The study medication was given 2 h before surgery and daily for up to 6 days after operation. The aim was to determine whether prucalopride improved return of gut function and reduced the incidence of PPOI. The primary endpoint was time to passage of stool and tolerance of diet (GI-2). Participants were allocated in a 1 : 1 ratio, in blocks of 10. Randomization was computer-generated. All study personnel, medical staff, and patients were blinded. RESULTS: This study was completed between October 2017 and May 2020 at two tertiary hospitals in New Zealand. A total of 148 patients were randomized, 74 per arm. Demographic data were similar in the two groups. There was no difference in median time to GI-2 between prucalopride and placebo groups: 3.5 (i.q.r. 2-5) versus 4 (3-5) days respectively (P = 0.124). Prucalopride improved the median time to passage of stool (3 versus 4 days; P = 0.027) but not time to tolerance of diet (2 versus 2 days; P = 0.669) or median duration of hospital stay (4 versus 4 days; P = 0.929). In patients who underwent laparoscopic surgery (125, 84.5 per cent), prucalopride improved median time to GI-2: 3 (2-4) days versus 4 (3-5) days for placebo (P = 0.012). The rate of PPOI, complications, and adverse events was similar in the two groups. CONCLUSION: Prucalopride did not improve time to overall recovery of gut function after elective colorectal surgery. Registration number: NCT02947269 (http://www.clinicaltrials.gov).


Assuntos
Benzofuranos , Cirurgia Colorretal , Procedimentos Cirúrgicos Eletivos , Íleus , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Benzofuranos/farmacologia , Benzofuranos/uso terapêutico , Cirurgia Colorretal/efeitos adversos , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Íleus/tratamento farmacológico , Íleus/etiologia , Nova Zelândia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Centros de Atenção Terciária
16.
Int J Surg ; 103: 106651, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35623600

RESUMO

INTRODUCTION: Ileus (delayed return of bowel function after surgery) is one of the highest priority research questions in modern day colorectal practice. Current Enhanced Recovery After Surgery (ERAS) guidance either does not include a specific recommendation for volume of postoperative oral fluids/foodstuffs or suggests ad-lib fluids. It is unclear if the volume of intake affects ileus rates. This systematic review aimed to determine the optimal fluid volume for patients to consume day one after elective colorectal surgery. METHODS: The literature was searched across seven databases, September 23, 2020. Randomised controlled trials of adults undergoing elective colorectal surgery, comparing oral intake postoperatively were eligible for inclusion. Two blinded reviewers assessed papers with disagreements resolved by a third independent reviewer. Main outcomes were 'resolution of postoperative ileus' and 'length of hospital stay'. Secondary outcomes included vomiting, mortality and complications. RESULTS: Of 2175 screened papers, eight were eligible for inclusion. All studies gave a clear liquid diet postoperatively. The comparison groups followed a traditional nil-by-mouth approach. All studies showed a minor reduction in postoperative ileus and hospital stay in the intervention group, but we are unable to determine the optimal postoperative oral fluid volume. The low number and poor quality of studies was a significant limitation. None of the trials were conducted within an ERAS protocol: only 883 patients were included in total. CONCLUSIONS: From the current literature it is unclear how postoperative oral fluid volume intake affects gastrointestinal function and ileus in elective colorectal surgical patients. This remains an important area for further research.


Assuntos
Neoplasias Colorretais , Cirurgia Colorretal , Íleus , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Íleus/etiologia , Íleus/prevenção & controle , Íleus/cirurgia , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fatores de Tempo
17.
World J Urol ; 40(6): 1311-1316, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35568722

RESUMO

PURPOSE: Implementation of enhanced recovery protocols in cystectomy patients has significantly changed the perioperative course of this major operation. This paper summarizes evidence based interventions to enhance the postoperative course of radical cystectomy. METHODS: A comprehensive search of PubMed and Embase databases was performed and also the results of our institutional enhanced recovery protocol were discussed. RESULTS: One of the major advantages of such changes is the reduced rate of postoperative gastrointestinal (GI) complications especially postoperative ileus which could be contributed to several components of these protocols. However, Alvimopan is the only component which its use is supported by level I evidence. Although there are some evidence suggesting the decreased rate of urinary tract infection with the use of prophylactic antibiotics and wound complications by the use of negative wound pressure devices, their clear benefit is yet to be shown. Although robotic approach has proven advantages in intraoperative blood loss and postoperative blood transfusion rate, surgical team's experience and dedicated infrastructure seem to be more influential in optimized outcome than just the surgical approach. CONCLUSION: current evidence suggests that such protocols have not only reached the goal of maintaining complication rate while decreasing length of hospital stay, but it might have caused a decrease in the rate of low-grade complications, especially GI complications.


Assuntos
Íleus , Neoplasias da Bexiga Urinária , Cistectomia/efeitos adversos , Cistectomia/métodos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Íleus/prevenção & controle , Tempo de Internação , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Bexiga Urinária/tratamento farmacológico
19.
J Minim Invasive Gynecol ; 29(7): 832-839, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35533955

RESUMO

OBJECTIVE: To compare perioperative outcomes between knotless barbed sutures (KBSs) and conventional smooth sutures for uterine incision closure at cesarean section. DATA SOURCES: MEDLINE, EMBASE, Web of Sciences, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from the inception of the study to March 2021 without language restriction. The search terms were as follows: ["Stratafix" OR "Quill" OR "V-Loc" OR "Barbs" OR "barbed"] AND ["Cesarean" OR "Caesarean"] AND ["Suturing" OR "Suture" OR "Closure" OR "Repair"]. Moreover, these terms were combined to complete the search. METHODS OF STUDY SELECTION: Retrospective and randomized peer-reviewed studies comparing the use of KBSs and conventional sutures for uterine incision closure at cesarean section were included. The studies' quality was assessed by the Cochrane risk-of-bias tool. The primary outcome was the time of uterine incision closure in seconds. The secondary outcomes included total operating time (minutes), use of additional hemostatic sutures, rates of blood transfusion, and postoperative complications. TABULATION, INTEGRATION, AND RESULTS: Of 20 reports identified, 4 representing 3332 women (1473 with KBSs and 1859 with conventional sutures) were eligible. All studies were judged to be at low risk of bias. The uterine incision closure time was significantly lower in the KBS group (mean difference, -110.58; 95% confidence interval [CI], -127.37 to -93.79; p = .001). Furthermore, the rate of use of additional hemostatic sutures was significantly lower in the KBS group (odds ratio, 0.14; 95% CI, 0.07-0.26; p = .001). Total operative time, rates of blood transfusion, febrile morbidity, and length of postoperative stay were comparable. The incidence of postoperative ileus was significantly lower in the KBS group (odds ratio, 0.31; 95% CI, 0.11-0.89; p = .029). CONCLUSION: The use of KBSs for uterine incision closure was associated with decreased hysterotomy closure time and less frequent need for the placement of additional hemostatic sutures. Other perioperative outcomes were not affected, although the risk of postoperative ileus was reduced.


Assuntos
Hemostáticos , Íleus , Cesárea/efeitos adversos , Feminino , Humanos , Histerotomia , Complicações Pós-Operatórias/etiologia , Gravidez , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
20.
Surg Laparosc Endosc Percutan Tech ; 32(4): 425-430, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404875

RESUMO

AIM: This study was performed to clarify the relationship between robotic rectal resection and postoperative ileus (POI) by comparing robotic surgery with laparoscopic surgery. MATERIALS AND METHODS: We retrospectively reviewed 238 patients who underwent robotic (n=41) or laparoscopic (n=197) rectal resection for rectal cancer in our institution from January 2013 to June 2020. First, we compared the background factors and short-term surgical outcomes between robotic and laparoscopic surgery. Next, we investigated the postoperative complications of robotic and laparoscopic rectal resection. Finally, we identified the risk factors for POI following rectal cancer resection. RESULTS: The percentages of patients with an Rb tumor location, treatment by abdominoperitoneal resection/intersphincteric resection/low anterior resection, a temporary diverting ileostomy, and a long operation time were significantly higher in robotic than laparoscopic surgery ( P <0.0001, P =0.0002, P =0.0078, and P =0.0001, respectively). There was no significant difference in any individual postoperative complication between robotic and laparoscopic surgery. Risk factors for POI were male sex ( P =0.0078), neoadjuvant chemoradiotherapy ( P =0.0007), an Rb tumor location ( P =0.0005), treatment by abdominoperitoneal resection/intersphincteric resection/low anterior resection ( P =0.0044), a temporary diverting ileostomy ( P <0.0001), and operation time of ≥240 minutes ( P =0.0024). Notably, robotic surgery was not a risk factor for POI following rectal resection relative to laparoscopic surgery. CONCLUSION: Although patients who underwent robotic surgery had more risk factors for POI, the risk of POI was similar between robotic and laparoscopic rectal resection.


Assuntos
Íleus , Laparoscopia , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Íleus/etiologia , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/patologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
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