[Influence of alpha and beta blocking agents on recovery of intestinal transit and postoperative complications in aged patients]

Following the recovery of intestinal peristaltic movements in medium and advanced age patients in whom major surgery had been performed, after an adequate preparation with and blocking agents, as compared with the control group, a shortening was noted, of the intestinal paresis period in both age groups. The early recovery of intestinal transit had positive effects on the postoperative evolution of the patients, especially in the aged ones, and allowed for an early resumption of oral alimentation, reducing abdominal meteorization, as well as the number and the severity of local and general complications.

[Closed intestinal decompression in postoperative paralysis: intestinal intubation (author's transl)]

Paralytic distension is a causative or important factor in the pathogenesis of early postoperative intestinal obstruction. The elimination of intestinal distension initiates a decisive change in the course of this disease. The long intestinal tube--comparable to an "intraluminary stoma"--renders the necessary intestinal decompression. The controlled placement of the tube using a gastroscope rules out technical problems. The procedure is highly effective, contributes to the reduction of relaparotomies, and avoids enterotomies with all their inherent risks in the state of ileus.

Postsurgical decompression and immediate elemental feeding

The paralytic ileus, poor nutritional state, and related complications that often develop following serious serious abdominal surgery have traditionally been accepted as unavoidable. Now, a nasogastric decompression and feeding tube is availabe that usually prevents paralytic ileus and also provides a complete liquid diet starting immedicately after the operation, thus speeding wound healing and recivery.

[Paralytic and postoperative ileus (author's transl)]

Paralytic ileus is always a reaction of the organism to a disturbance usually due to metabolism. A treatment without elimination of the eliciting cause seems, therefore, to have little point. The efficacy of many substances given to stimulate peristalsis has not been proved. Drawing off the contents of the stomach and controlled infusion therapy, on the other hand, are important parts of the treatment, as for mechanical ileus. For the surgical emptying of the intestine, the most suitable procedure is retrograde squeezing of the intestinal contents to the stomach and aspiration through a nasal sound. Enterotomies should be avoided if at all possible. Surgical intervention for paralytic ileus is most frequently necessary in the postoperative phase, usually caused by a peritonitis with or without anastomotic failure. Differentiation from mechanical obstruction is not always possible. In the Erlangen Hospital, 233 patients were treated for postoperative ileus from 1965 to 1974. All patients with a mechanical ileus were operated on, the mortality was 17%. Of 123 patients with a paralytic ileus, 82 were operated on and 45 died. The mortality was almost equally high in patients not operated on.

[Electric stimulation of intestinal motility in the postoperative period]

The authors performed 208 electric stimulations of the bowel motor activity with the aim of prophylaxis and treatment of its postoperative paresis. The studies have shown that electric stimulation accelerated considerably the process of rehabilitation of the bowel motor function, but it would not prevent the development of grave functional intestinal obstruction. But nevertheless electric stimulation is a highly effective method in the complex of measures for treatment of grave functional intestinal obstruction. Electric stimulation of the bowel should be introduced in every day practice of intensive postoperative care departments.

[Replacement of the bladder with isolated intestinal loop]

Based on the experience with 98 operations performed for replacement of the urinary bladder with an isolated intestinal segment, it was demonstrated that the most frequent complications were peritonitis, inflammation of the lung that develop mainly with the postoperative paresis of the digestive tract in the background. Therefore, a complex of prophylactic and therapeutic measures for the postoperative intestinal paresis is recommended, the technic of surgical intervention being described in detail. A comparison of the results of surgery, taking into account the mode of the urine outflow in cystectomy, enabled to consider cystectomy with replacement of the bladder with an intestinal graft as the method of choice.