Prolonged postoperative ileus following right‐ versus left‐sided colectomy: A systematic review and meta‐analysis

Abstract

Aim: Prolonged postoperative ileus (PPOI) is a common complication following colonic surgery, and is associated with longer hospital stay, greater risk of complications and substantial cost for patients and hospitals. Some reports have recently suggested that gastrointestinal (GI) recovery varies based on the side of resection (i.e., right-sided vs. left-sided colectomy). This systematic review and meta-analysis aimed to compare GI recovery by resection side. Methods:The MEDLINE, Embase, Cochrane Library and CENTRAL databases were systematically searched for articles reporting GI recovery outcomes in adults undergoing elective right-versus left-sided colectomy (excluding with ileostomy) of any surgical approach. The primary outcome was PPOI, and secondary outcomes included time to first passage of flatus, stool and tolerance of solid diet, and postoperative complications.Subgroup analyses of laparoscopic procedures and cohorts without inflammatory bowel disease and sensitivity analysis of adjusted multivariate results were also performed.Results: Nine studies were identified, of which seven were included in the meta-analysis, comprising 29 068 colectomies (14 581 right-sided; 14 487 left-sided). PPOI was heterogeneously defined and was significantly more likely following right-sided compared to left-sided colectomy regardless of the surgical approach (OR 1.78, 95% CI 1.32-2.39; P < 0.01; I 2 = 51%), as well as on subgroup analyses and adjusted multivariate metaanalysis. Secondary outcomes were reported in only a few small studies; hence metaanalysis did not produce reliable results. Conclusion:Based on heterogeneous definitions, consistently higher rates of PPOI were observed following right-versus left-sided colectomy. These differences are currently unexplained and highlight the need for further research into the pathophysiology of ileus.

Comparing return of bowel function after right versus extended right hemicolectomy: a retrospective analysis

“…ERH led to increased postoperative Hb drop in this series, which has also been demonstrated to be an independent risk factor for PPOI 17 . Reported rates of ileus following right‐sided colonic resections are variable (15–36%), 6,11,15,17,20 with considerable heterogeneity in defining PPOI 1,9 . The rates of PPOI in this study (80/293, 27% over the whole sample) are higher than most reported in the literature, although local studies have reported similarly high rates of PPOI, including at 36% in a cohort where the same rigorous definition for PPOI was utilized and open/laparoscopic techniques were more equally represented than in our sample 15,17 …”

“…Recent systematic review discusses a number of possible underlying mechanisms why PPOI is more common following right (vs. left)‐sided colorectal resections 9 . Rectosigmoid motor hyperactivity following right sided resections, demonstrated by high‐resolution manometry, has been suggested as a contributor towards PPOI 10 .…”

“…19 Recent systematic review discusses a number of possible underlying mechanisms why PPOI is more common following right (vs. left)-sided colorectal resections. 9 Rectosigmoid motor hyperactivity following right sided resections, demonstrated by highresolution manometry, has been suggested as a contributor towards PPOI. 10 This hypothesis may be supported by no significant difference in PPOI after ERH versus RH, although the pathophysiology of ileus remains incompletely understood.…”

“…Interestingly, right-sided (compared to left-sided) colorectal resections are associated with higher rates of PPOI. 9 The reasons for this are incompletely understood, although rectosigmoid hyperactivity, loss of the ileocaecal valve and increased sympathetic activity due to small bowel trauma may play a role 10,11 .…”

Incidence of and risk factors for postoperative ileus between right and left laparoscopic colectomy using propensity‐score‐matched analysis: A retrospective multicenter study

“…2 Previous reports have shown a difference in the occurrence of POI after colorectal cancer surgery between the left and right sides, with the right-side colon being at higher risk than the left-side colon. 4,5 Factors reported to contribute to POI include clinical features, epidemiological features, histological characteristics, and molecular biological differences between sides. [6][7][8] However, past reports have included various biases such as single-center reports, small study cohorts, and perioperative management differing from that in recent years.…”