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

Abstract

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.

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

“…7,8 The average estimated blood loss of the laparoscopic approach was universally lower open approach, but warm ischemia time (WIT) was longer. 9,10 In a matched-pair study, the renal function was poorer in the laparoscopic PN cohort in the shortterm after surgery. 11 There is no difference in PFS or OS between laparoscopic PN (LPN) and open PN (OPN) with laparoscopic expertise.…”

Comparison of prolonged postoperative ileus between laparoscopic right and left colectomy under enhanced recovery after surgery: a propensity score matching analysis

“…Compared with open colectomy, laparoscopic colectomy has many advantages, such as faster postoperative return of bowel function, fewer complications, less pain, fewer hospital stays, and similar long-term effect [ 16 – 18 ]. The clinical practice guideline for enhanced recovery after colon and rectal surgery from the ASCRS and SAGES strongly recommends employing a minimally invasive surgical approach whenever expertise is available and appropriate for colon cancer [ 8 ].…”

Actual compliance rate of Enhanced Recovery After Surgery protocol in laparoscopic distal gastrectomy

“…The second most common reason for noncompliance was postoperative ileus (n = 111, 11.0%). Liang et al [ 18 ] reported that the proportion of patients with ileus after laparoscopic gastrectomy was 14.14%. Huang et al [ 19 ] reported ileus after laparoscopic gastrectomy in 18.52% of patients.…”

“…As a result, it is expected that the inflammatory response or decreased intestinal motility after surgery is more severe. These factors are thought to increase the likelihood of noncompliance [ 18 , 19 ].…”