Management strategies of postoperative gastrointestinal tract dysfunction:a review of 210 cases

The role of traditional Chinese medicine in postoperative wound complications of gastric cancer

Due to the high risks of postoperative complications brought on by gastric cancer, traditional Chinese medicine (TCM) as a commonly used therapy, has exerted its vital role in postoperative recovery care. In this sense, this meta-analysis was conducted to explore the related documents about TCM's impact on gastric cancer postoperative recovery. During the research, we explored a total of 1549 results from databases PubMed, China National Knowledge Infrastructure (CNKI), Embase, Cochrane Library and Web of Science (WoS). Thirty-two clinical randomized trials (RCTs) were then selected and analysed for this meta-analysis by using the software RevMan 5.4 (under PRISMA 2020 regulations), with a population of 3178 patients. Data prove that TCM therapy reduced the risks for postoperative complications exposure by an estimated average of 19% (95% CI). Among the complications, TCM therapy suppressed the risks of wound infection and incisional infections by 53% and 48% respectively. Meanwhile, the patient's wound healing duration exhibited a significant reduction compared to those without TCM treatment, with a difference at around 0.74 days (95% CI). TCM also exerted its potential to strengthen the patient's immune and health conditions, leading to a significantly promoted gastrointestinal function in the patients with a shorter duration to release first exhaustion and defecation compared to those with no TCM therapy. In addition, similar promoted phenomena also exist in those patients with TCM therapy in terms of their immunity and nutritional conditions. These facts all indicate a positive impact of TCM therapy in clinical applications.

Effectiveness of acupuncture for postoperative gastrointestinal recovery in patients undergoing thoracoscopic surgery: a prospective randomized controlled study

BACKGROUND

Postoperative gastrointestinal dysfunction (PGD) is one of the most common complications among patients who have undergone thoracic surgery. Acupuncture has long been used in traditional Chinese medicine to treat gastrointestinal diseases and has shown benefit as an alternative therapy for the management of digestive ailments. This study aimed to explore the therapeutic effectiveness of acupuncture as a means to aid postoperative recovery of gastrointestinal function in patients undergoing thoracoscopic surgery.

METHODS

In total, 112 patients aged 18-70 years undergoing thoracoscopic surgery between 15 June 2022 and 30 August 2022 were randomized into two groups. Patients in the acupuncture group (AG) first received acupuncture treatment 4 h after surgery, and treatment was repeated at 24 and 48 h. Patients in the control group (CG) did not receive any acupuncture treatment. Both groups received the same anesthetic protocol. Ultrasound-guided thoracic paravertebral block (TPVB) was performed in the paravertebral spaces between T4 and T5 with administration of 20 mL of 0.33% ropivacaine. All patients received patient-controlled intravenous analgesia (PCIA) after surgery.

RESULTS

Median time to first flatus [interquartile range] in the AG was significantly less than in the CG (23.25 [18.13, 29.75] vs 30.75 [24.13, 45.38] h, p < 0.001). Time to first fluid intake after surgery was significantly less in the AG, as compared with the CG (4 [3, 7] vs 6.5 [4.13, 10.75] h, p = 0.003). Static pain, measured by visual analog scale (VAS) score, was significantly different on the third day after surgery (p = 0.018). Dynamic pain VAS scores were lower in the AG versus CG on the first three postoperative days (p = 0.014, 0.003 and 0.041, respectively).

CONCLUSION

Addition of acupuncture appeared to improve recovery of postoperative gastrointestinal function and alleviate posteoperative pain in patients undergoing thoracoscopic surgery. Acupuncture may represent a feasible strategy for the prevention of PGD occurrence.

TRIAL REGISTRATION NUMBER

ChiCTR2200060888 (Chinese Clinical Trial Registry).

Patient-reported gastrointestinal symptoms following surgery for gastric cancer and the relative risk factors

Purpose

The study aims to assess the incidence of short-term patient-reported postoperative gastrointestinal symptoms (PGISs) after gastric cancer surgery and explore the relative risk factors for the symptoms.

Methods

Patients with radical gastrectomy were included for this retrospective and observational study. Symptoms extracted from the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI) were collected in postdischarge week (PDW) 1 and postoperative month (POM) 1. The distributing states of symptoms were analyzed in PDW1 and POM1. Logistic regression models were used to identify risk factors for PGISs.

Results

Among 356 patients with complete interviews, 156 (43.8%) patients reported abdominal distention in PDW1, which was significantly higher than patients in POM1 [103 (28.9%), p &lt; 0.001]. Pain (15.2% vs. 9.8%), dysphagia (5.6% vs. 7.0%), diarrhea (3.7% vs. 3.4%), and vomiting (2.5% vs. 2.8%) had no significant differences between PDW1 and POM1. Logistic models found that risk factors for PGISs were total gastrectomy [odds ratio (OR): 1.948; 95% CI: 1.097–3.459; p = 0.023] and disturbed sleep (OR: 3.116; 95% CI: 1.831–5.303; p &lt; 0.001) in PDW1 and female gender (OR: 1.726; 95% CI: 1.071–2.782; p = 0.025), total gastrectomy (OR: 1.729; 95% CI: 1.055–2.834; p = 0.030), and disturbed sleep (OR: 3.533; 95% CI: 1.757–7.106; p &lt; 0.001) in POM1.

Conclusions

The main symptom after gastric cancer surgery was abdominal distention. The relative risk factors for gastrointestinal symptoms after gastric cancer surgery were total gastrectomy and disturbed sleep. Timely symptom intervention may improve the quality of life of postgastrectomy patients.

Application of Refined Nursing Combined with Comprehensive Treatment of Traditional Chinese and Western Medicine in Gastrointestinal Dysfunction after Tumor Operation

After surgical treatment, the gastrointestinal function of tumor patients is inhibited for a short time. Refined nursing is beneficial to the recovery of gastrointestinal function of tumor patients after operation. Traditional Chinese medicine and Western medicine have their own advantages in the treatment of gastrointestinal dysfunction after tumor operation and the combined application of the two is more ideal. Therefore, on the premise of refined nursing, we should carefully study the efficacy of integrated traditional Chinese and Western medicine in the treatment of postoperative gastrointestinal dysfunction in tumor patients. Fifty patients with gastrointestinal dysfunction after tumor surgery admitted to Xiamen University Affiliated Zhongshan Hospital from June 2021 to August 2022 were retrospectively selected. Twenty two of them received refined care + Western medicine (control group, CG) and the other 28 received refined care + Western medicine + moxibustion and thumb-tack needle Chinese medicine (observation group, OG). We compared the recovery of gastrointestinal function, inflammatory factors, negative emotions, sleep quality, length of stay, medical expenses, and adverse reactions. The postoperative recovery effect of gastrointestinal function in the OG was better than that in the CG. The IL-8 level and TNF -α level in OG were lower than those in CG. Relative to CG, the OG had significantly low SDS scores, SAS scores, PSQ1 scores, length of hospital stay, and medical expenses. The OG incidence of adverse reactions was 28.57%; it was significantly lower than 59.09% in the CG. Refined nursing with integrated Chinese and Western medicine therapeutic interventions can promote the recovery of gastrointestinal tract function, relieve anxiety and depression, and improve sleep quality in patients with postoperative gastrointestinal dysfunction after tumor surgery.