Variable Gut Function Recovery After Right vs. Left Colectomy May Be Due to Rectosigmoid Hyperactivity

Seo, Sean Ho Beom; Bissett, Ian; O’Grady, Gregory

doi:10.3389/fphys.2021.635167

Cited by 10 publications

(16 citation statements)

References 24 publications

(34 reference statements)

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“…Following a meal stimulus, cyclic motor patterns occur in the rectosigmoid colon, predominantly retrograde, operating as a 'rectosigmoid brake' to limit rectal filling [40]. Marked and prolonged cyclic motor pattern hyperactivity occurs following right-sided colectomy, which could induce a temporary functional obstruction [39,41]. Resecting this region of the rectosigmoid colon where hyperactivity arises, as typically occurs during left-sided colectomy, has therefore been hypothesized…”

Section: Ta B L E 4 Covariates Included In Multivariate Analyses Performed By Individual Studiesmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Ta B L E 4 Covariates Included In Multivariate Analyses Performed By Individual Studiesmentioning

confidence: 99%

“…to shorten the relative time to GI functional recovery compared to right-sided colectomy [41]. However, further physiological studies are now needed to test these hypotheses and their clinicopathological relevance.…”

Section: Ta B L E 4 Covariates Included In Multivariate Analyses Performed By Individual Studiesmentioning

confidence: 99%

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

et al. 2021

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“…The impacts of PPOI for patients and healthcare systems are considerable, 6–8,22 though the duration and severity are variable 3 . Terms such as ‘paralytic’ and ‘adynamic’ ileus have previously been used to describe PPOI; these should be avoided given there is increasing evidence the gut is not paralysed, but rather hyperactive dysmotility patterns may be responsible for impaired transit 23–25 . Although the definition of PPOI remains controversial, this dichotomisation has demonstrated clinical and economic impacts associated with prolonged recovery, 6–8,22 and serves as a useful marker and target for intervention.…”

Section: Definition Of Post‐operative Ileusmentioning

confidence: 99%

Post‐operative ileus: definitions, mechanisms and controversies

Wells

Milne

Seo

et al. 2021

ANZ Journal of Surgery

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Post‐operative ileus (POI) is a syndrome of impaired gastrointestinal transit which occurs following abdominal surgery. There are few effective targeted therapies for ileus, and research has been limited by inconsistent definitions and an incomplete understanding of the underlying pathophysiology. Despite considerable effort, there remains no widely‐adopted definition of ileus, and recent work has identified variation in outcome reporting is a major source of heterogeneity in clinical trials. Outcomes should be clearly‐defined, clinically‐relevant, and reflective of the underlying biology, impacts on hospital resources and quality of life. Further collaborative efforts will be needed to develop consensus definitions and a core outcome set for postoperative gastrointestinal recovery. Investigation into the pathophysiology of POI has been hindered by use of low‐resolution techniques and difficulties linking cellular mechanisms to dysmotility patterns and clinical symptoms. Recent evidence has suggested the common assumption of post‐operative GI paralysis is incorrect, and that the distal colon becomes hyperactive following surgery. The post‐operative inflammatory response is important in the pathophysiology of ileus, but the time course of this in humans remains unclear, with the majority of evidence coming from animal models. Future work should investigate dysmotility patterns underlying ileus, and identify biomarkers which may be used to diagnose, monitor and stratify patients with ileus.

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“…Altered CMPs have been implicated in the pathophysiology of constipation (10,11) and low anterior resection syndrome (12). Hyperactive CMPs have previously been observed intra-operatively while patients are under general anaesthesia for abdominal surgery, potentially representing a novel effect of the surgical stress response (13,14). CMPs are also a target of emerging diagnostics such as high-resolution body surface mapping (15,16), and may be a relevant biomarker for therapeutic sacral neuromodulation (17).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Serosal Extracellular Mapping of the Human Distal Colon: A Feasibility Study

Lin

Varghese

et al. 2021

Preprint

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Background:Cyclic motor patterns (CMP) are the predominant motor pattern in the distal colon, and are important in both health and disease. Their origin, mechanism and relation to bioelectrical slow-waves remain incompletely understood. During abdominal surgery, an increase in the CMP occurs in the distal colon. This study aimed to evaluate the feasibility of detecting propagating slow waves and spike waves in the distal human colon through intraoperative, high-resolution (HR), serosal electrical mapping. Methods:HR electrical recordings were obtained from the distal colon using validated flexible PCB arrays (6 x 16 electrodes; 4 mm inter-electrode spacing; 2.4 cm2, 0.3 mm diameter) for up to 15 minutes. Passive unipolar signals were obtained and analysed.Results:Eleven patients (33-71 years; six females) undergoing colorectal surgery under general anaesthesia (4 with epidurals) were recruited. After artifact removal and comprehensive manual and automated analytics, events consistent with regular propagating activity between 2-6 cpm were not identified in any patient. Intermittent clusters of spike-like activities lasting 10-180 s with frequencies of each cluster ranging between 24-42 cpm, and an average amplitude of 0.54 ± 0.37 mV were recorded.Conclusions:Intra-operative colonic serosal mapping in humans is feasible, but unlike in the stomach and small bowel, revealed no regular propagating electrical activity, although sporadic, synchronous spike-wave events were identifiable. Alternative techniques are required to characterise the mechanisms underlying the hyperactive CMP observed in the intra- and post-operative period.

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Variable Gut Function Recovery After Right vs. Left Colectomy May Be Due to Rectosigmoid Hyperactivity

Cited by 10 publications

References 24 publications

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

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

Post‐operative ileus: definitions, mechanisms and controversies

Intraoperative Serosal Extracellular Mapping of the Human Distal Colon: A Feasibility Study

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