Effect of abdominal hot pack application on gastrointestinal motility recovery after comprehensive gynecologic staging surgery

Abstract

ObjectiveTo evaluate whether abdominal hot water pack application improves gastrointestinal motility following gynecological oncology surgery.MethodsThe study was registered at ClinicalTrials.gov (NCT04833699). (https://clinicaltrials.gov/ct2/show/NCT04833699?cond=NCT04833699&draw=2&rank=1). In this randomized controlled trial, participants were randomly assigned (1:1) to the hot water pack group (standardized enhanced recovery protocols plus rubber water bag with a fluffy cover filled with boiled tap water [80°C] and placed on the abdomen at 3, 6, 9, and 12 h postoperatively for 30 min each time) or the control group (standardized enhanced recovery protocols). A subumbilical or supraumbilical vertical midline incision was made to perform staging surgery procedures, including hysterectomy, salpingo‐oophorectomy with retroperitoneal lymphadenectomy. The primary outcome was the time to first passage of flatus from the end of the staging procedure.ResultsIn total, 121 women were randomized to the control (n = 62) or hot water pack (n = 59) group. The use of an abdominal hot water pack significantly reduced the mean time to passing first flatus (25.2 ± 3.6 vs. 30.6 ± 3.9 h; hazard ratio [HR] = 4.4; 95% confidence interval [CI]: 2.8–7.1; P < 0.0001), mean time to first bowel movements (28.4 ± 4.0 vs. 34.4 ± 4.5 h; HR = 4.9; 95% CI: 3.0–7.9; P < 0.0001), mean time to first defecation (33.4 ± 4.9 vs. 41.0 ± 7.6 h; HR = 4.3; 95% CI: 2.1–6.8; P < 0.0001), and mean time to tolerating solid diet (2.1 ± 0.6 vs. 2.8 ± 1.0 days; HR = 4.4; 95% CI: 2.2–8.7; P < 0.0001) compared to the control group. The postoperative ileus incidence was significantly lower in the hot water pack group (3.4%) than the control group (16.1%) (P = 0.01).ConclusionAbdominal hot water pack application improved gastrointestinal function recovery in women following surgical staging procedures for gynecological malignancy.

Validity of the I‑FEED classification in assessing postoperative gastrointestinal impairment in patients undergoing elective lumbar spinal surgery with general anesthesia: a prospective observational study

“…The total score, ranging from 0 to 14, is calculated and summed for each postoperative day, and the highest overall score is used to categorize patients into one of three categories: normal (0–2 points), postoperative gastrointestinal intolerance (POGI; 3–5 points), and postoperative gastrointestinal dysfunction (POGD; 6 + points). These three categories have been applied in colorectal surgery, abdominal surgery, and gynecological surgery to provide a consistent and objective definition of postoperative gastrointestinal function, as well as the trajectory of postoperative gastrointestinal recovery (Alsharqawi et al 2020 ; Leung et al 2021 ; McLemore et al 2022 ; Lu et al 2021 ; Gungorduk et al 2024 ). A brief explanation of the three categories is summarized below: Normal (score 0–2): These patients tolerate a diet without symptoms of bloating but may experience transient PONV or mild abdominal distension within 24–48 h after surgery.…”