Increased incidence of prolonged ileus after colectomy for inflammatory bowel diseases under ERAS protocol: a cohort analysis

Dai, X.; Ge, Xiaolong; Yang, Jianbo; Zhang, Tenghui; Xie, Tingbin; Gao, Wen; Gong, Jianfeng; Zhu, Weiming

doi:10.1016/j.jss.2016.12.031

Cited by 47 publications

(38 citation statements)

References 55 publications

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“…The present study provides a potential explanation for side-specific delayed intestinal recovery: Crohn's disease. Similar observations were made by a recent Chinese report: 184 patients with inflammatory bowel disease (IBD) were matched and compared with 250 patients with colorectal cancer [16]. This latter cohort underwent heterogeneous elective and emergent colorectal procedures; a POI rate of 9.8% in patients with IBD compared with 4% in patients with cancer was described.…”

Section: Discussionsupporting

confidence: 72%

Comparison of recovery and outcome after left and right colectomy

et al. 2019

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Aim The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30‐day complications, were compared between left‐sided and right‐sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left‐sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion Despite equal ERP compliance, postoperative ileus was higher after right‐sided colectomies. This finding was associated with Crohn's disease and fluid overload.

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Section: Discussionsupporting

confidence: 72%

Comparison of recovery and outcome after left and right colectomy

et al. 2019

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“…Furthermore, stratified analyses demonstrated that laparoscopy approach had strong protective effects in the subgroup patients with high level of postoperative WBC. In our study, the frequency of PPOI after gastric surgery was 19.75%, which was lower to that reported by Huang 21,23 A global survey and systematic review extracted definitions from 52 identified trials and proposed 4 days as a standardized endpoint for PPOI. 2 It was well accepted in subsequent studies, and we also adopted this definition as diagnostic criteria in our study.…”

Section: Discussioncontrasting

confidence: 83%

“…There have been numerous reports on PPOI after colectomy with prediction or post hoc analyses . However, little is known about risk factors of PPOI for patients with gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Controversies have mainly focused on the duration of ileus that should be regarded as prolonged. An observational study of 2400 consecutive patients determined 3 days as prolonged ileus, whereas Dai et al specified 4 days and Artinyan et al defined more than 6 days . A global survey and systematic review extracted definitions from 52 identified trials and proposed 4 days as a standardized endpoint for PPOI .…”

Section: Discussionmentioning

confidence: 99%

“…There have been numerous reports on PPOI after colectomy with prediction or post hoc analyses. 3,17,18,21,22 However, little is known about risk factors of PPOI for patients with gastric cancer. This study analyzed 15 potential factors of PPOI after resection of gastric cancer in 162 patients.…”

Section: Discussionmentioning

confidence: 99%

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Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

Liang

Zhang

et al. 2019

Cancer Medicine

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Background Prolonged postoperative ileus (PPOI) is a common complication after abdominal surgery, but data about risk factors of PPOI for patients with gastric cancer are rare. We sought to investigate the impact of laparoscopic versus open surgery for PPOI after gastric cancer surgery. Methods A retrospective cohort study was conducted using a registry database consecutively collected from June 2016 to March 2017. PPOI was defined as no bowel function persisting for more than 4 days. Univariate analysis and multiple logistic regression models were performed to investigate risk factors, and stratified analysis was carried out to examine the primary association at different levels of a potential confounding factor. Results A total of 162 patients composed of 63 patients undergoing laparotomy and 99 patients undergoing laparoscopy were enrolled and PPOI was observed in 32 (19.75%) patients. Risk factors significantly correlated with PPOI were as follows: open surgery, older age, late surgical pathologic staging, postoperative use of opioid analgesic, low level of postoperative albumin and serum potassium. Compared to open surgery, the laparoscopic surgery was a strong protective factor for PPOI after adjusting related variables (OR = 0.17, CI: 0.05‐0.52, P = .002). There was an interaction between surgical methods and the postoperative WBC level (P for interaction = .007). In the two group stratified analysis of WBC, laparoscopic surgery had a significant lower risk of PPOI than open group for the patients with WBC counts above the middle level in crude or adjusted models. This result remained significantly in the three group stratified analysis for the patients with WBC counts in the middle and or high tertile groups. Conclusions PPOI is a common postoperative complication of patients after gastrectomy. Laparoscopic surgery is associated with decreased risk of PPOI in gastric surgery. Patients who underwent open surgery and presented with high level of WBC should be cautious with PPOI.

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The Use of Enhanced Recovery Pathways in Patients Undergoing Surgery for Inflammatory Bowel Disease

Cannon

2019

Mastery of IBD Surgery

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Increased incidence of prolonged ileus after colectomy for inflammatory bowel diseases under ERAS protocol: a cohort analysis

Cited by 47 publications

References 55 publications

Comparison of recovery and outcome after left and right colectomy

Comparison of recovery and outcome after left and right colectomy

Prolonged postoperative ileus in gastric surgery: Is there any difference between laparoscopic and open surgery?

The Use of Enhanced Recovery Pathways in Patients Undergoing Surgery for Inflammatory Bowel Disease

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