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Amin EA, Ismail E, Mahboobeh R, Tabandeh S. The effect of Cuminum cyminum on the return of bowel motility after abdominal surgery: a triple-blind randomized clinical trial. BMC Complement Med Ther 2024; 24:254. [PMID: 38965524 PMCID: PMC11229490 DOI: 10.1186/s12906-024-04530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/30/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Considering the significant prevalence of ileus after abdominal surgery and the beneficial effects of Cuminum cyminum in digestive problems, this study aimed to examine whether Cuminum cyminum has any effect on the return of bowel motility after abdominal surgery. MATERIALS AND METHODS In this triple-blind clinical trial study, 74 patients undergoing abdominal surgery were assigned to the intervention and control groups using minimization methods. The patients in the intervention group consumed 250 mg capsules containing Cuminum cyminum extract 4 h after the surgery and another dose of the drug 1 h afterward. The patients in the control group consumed a 250 mg capsule containing starch as a placebo at hours similar to those in the intervention group. The instruments used to collect the data were a demographic questionnaire and a researcher-made checklist to assess bowel habits. The data were analyzed using SPSS-22 software. RESULTS The average time of gas passing in the intervention and control groups was 9.03 ± 3.41 and 11.72 ± 4.21 h, respectively. The defecation times in the intervention and control groups were 16.97 ± 5.02 and 26 ± 9.87 h, showing a significant difference between the two groups as indicated by the independent samples T-test (P > 0.001). Furthermore, abdominal pain, abdominal bloating, nausea, and vomiting were significantly less frequent in the intervention group compared to the control group as confirmed by Fisher's exact test (P > 0.001). CONCLUSION According to the results, the consumption of Cuminum cyminum after abdominal surgery helps to reduce the time of gas passing, defecation, and the return of bowel motility. However, additional studies need to address the effectiveness of Cuminum cyminum by changing the time and duration of its use.
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Affiliation(s)
- Esmaeili Abdar Amin
- Medical Surgical Nursing Student, Student Research Committee, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Elahabadi Ismail
- Department of Surgery, Ali Ibn Abi Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Raeiszadeh Mahboobeh
- Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadeghi Tabandeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Liao KL, Wang HH, Yang LY, Hsu YF, Chou FH, Chu YC. Effectiveness of Chewing Gum on Nausea and Vomiting Following Postprocedure: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2024; 39:417-424.e2. [PMID: 38206218 DOI: 10.1016/j.jopan.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of chewing gum in reducing postprocedure nausea and vomiting. DESIGN A systematic review and meta-analysis. METHODS A systematic literature search was performed on MEDLINE Complete, EMBASE, CINAHL, PubMed, Web of Science, Academic Search Complete, and Cochrane Library databases from their inception to October 2, 2022. Methodological quality was assessed using the revised Cochrane Risk of Bias 2.0 tool for randomized trials. A meta-analysis was performed using a fixed-effects model to calculate pooled effects with Review Manager 5.4.1. FINDINGS Twelve randomized trials encompassing 1,458 participants were pooled. The chewing gum intervention was effective in reducing vomiting (P = .007; risk ratio = 0.55; 95% Cl = 0.35-0.85), but not nausea (P = .14; risk ratio = 0.84; 95% Cl = 0.66-1.06). Thirty-minute sessions of gum chewing were significantly more effective in reducing vomiting than 15-minute sessions (P = .04; risk ratio = 0.31; 95% Cl = 0.1-0.93). CONCLUSIONS The results indicate that repeated gum chewing sessions of at least 30 minutes may act as a nonpharmacological intervention for reducing vomiting. However, further studies are necessary to determine the outcomes of chewing gum interventions.
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Affiliation(s)
- Kuei-Lin Liao
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Li-Yu Yang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Yi-Chin Chu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Liu S, Fu W, Fu J, Chen G, He Y, Zheng T, Ma T. Electroacupuncture alleviates intestinal inflammation via a distinct neuro-immune signal pathway in the treatment of postoperative ileus. Biomed Pharmacother 2024; 173:116387. [PMID: 38471276 DOI: 10.1016/j.biopha.2024.116387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The induction of intestinal inflammation as a result of abdominal surgery is an essential factor in postoperative ileus (POI) development. Electroacupuncture (EA) at ST36 has been demonstrated to relieve intestinal inflammation and restore gastrointestinal dysmotility in POI. This study aims to elucidate the neuroimmune pathway involved in the anti-inflammatory properties of EA in POI. METHODS After intestinal manipulation (IM) was performed to induce POI, intestinal inflammation and motility were assessed 24 h post-IM, by evaluating gastrointestinal transit (GIT), cytokines expression, and leukocyte infiltration. Experimental surgery, pharmacological intervention, and genetic knockout mice were used to elucidate the neuroimmune mechanisms of EA. RESULTS EA at ST36 significantly improved GIT and reduced the expression of pro-inflammatory cytokines and leukocyte infiltration in the intestinal muscularis following IM in mice. The anti-inflammatory effectiveness of EA treatment was abolished by sub-diaphragmatic vagotomy, whereas splenectomy did not hinder the anti-inflammatory benefits of EA treatment. The hexamethonium chloride (HEX) administration contributes to a notable reduction in the EA capacity to suppress inflammation and enhance motility dysfunction, and EA is ineffective in α7 nicotinic acetylcholine receptor (α7nAChR) knockout mice. CONCLUSIONS EA at ST36 prevents intestinal inflammation and dysmotility through a neural circuit that requires vagal innervation but is independent of the spleen. Further findings revealed that the process involves enteric neurons mediating the vagal signal and requires the presence of α7nAChR. These findings suggest that utilizing EA at ST36 may represent a possible therapeutic approach for POI and other immune-related gastrointestinal diseases.
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Affiliation(s)
- Shuchang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Wei Fu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Jingnan Fu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China; Department of Minimally Invasive Surgery, Characteristics Medical Center of Chinese People Armed Police Force, Tianjin 300162, China
| | - Guibing Chen
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China; Department of Gastrointestinal Surgery, Clinical Medical College and The First Affilliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
| | - Yuxin He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Ting Zheng
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China.
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Cui Y, Zhang C, Zhang H, Zhang X, Tang Y, Wu Z, Wang T, Chen Q, Meng Y, Wang B, Liu M, Yi J, Shi Y, Li R, Pan H. Effect evaluation of different preventive measures for ileus after abdominal operation: A systematic review and network meta-analysis. Heliyon 2024; 10:e25412. [PMID: 38370213 PMCID: PMC10867618 DOI: 10.1016/j.heliyon.2024.e25412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/10/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background Different approaches to the prevention of postoperative ileus have been evaluated in numerous randomized controlled trials. This network meta-analysis aimed to investigate the relative effectiveness of different interventions in preventing postoperative ileus. Methods Randomized controlled trials (RCTS) on the prevention of postoperative ileus were screened from Chinese and foreign medical databases and compared. STATA software was used for network meta-analysis using the frequency method. Random-effects network meta-analysis was also used to compare all schemes directly and indirectly. Results A total of 105 randomized controlled trials with 18,840 participants were included in this report. The results of the network meta-analysis showed that intravenous analgesia was most effective in preventing the incidence of postoperative ileus, the surface under the cumulative ranking curve (SUCRA) is 90.5. The most effective intervention for reducing the first postoperative exhaust time was postoperative abdominal mechanical massage (SUCRA: 97.3), and the most effective intervention for reducing the first postoperative defecation time was high-dose opioid antagonists (SUCRA: 84.3). Additionally, the most effective intervention for reducing the time to initiate a normal diet after surgery was accelerated rehabilitation (SUCRA: 85.4). A comprehensive analysis demonstrated the effectiveness and prominence of oral opioid antagonists and electroacupuncture (EA) combined with gum. Conclusion This network meta-analysis determined that oral opioid antagonists and EA combined with chewing gum are the most effective treatments and optimal interventions for reducing the incidence of postoperative ileus. However, methods such as abdominal mechanical massage and coffee require further high-quality research.
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Affiliation(s)
- Yan Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
- Key Laboratory of Gansu Provincial Prescription Mining and Innovative Translational Laboratory, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Chengzu Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Hui Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xuan Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yuan Tang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Zhihang Wu
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Tianming Wang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Quanxin Chen
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Ying Meng
- Department of Pharmacy, Expo High-tech Hospital, Zibo, Shandong, China
| | - Bo Wang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Mei Liu
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
- Gansu Provincial Traditional Chinese Medicine New Product Creation Engineering Laboratory, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Jianfeng Yi
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yuhong Shi
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Richeng Li
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Haibang Pan
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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Emile SH, Horesh N, Garoufalia Z, Gefen R, Ray-Offor E, Wexner SD. Strategies to reduce ileus after colorectal surgery: A qualitative umbrella review of the collective evidence. Surgery 2024; 175:280-288. [PMID: 38042712 DOI: 10.1016/j.surg.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Various strategies were proposed to reduce postoperative ileus after colorectal surgery. This umbrella review aimed to provide a comprehensive overview of current evidence on measures to reduce the incidence and severity of postoperative ileus after colorectal surgery. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic search was conducted in PubMed and Scopus to identify systematic reviews that assessed the efficacy of interventions used to prevent postoperative ileus after colorectal surgery. Data on study characteristics, interventions, and outcomes were summarized in a narrative manner. RESULTS A total of 26 systematic reviews incorporating various strategies like early oral feeding, gum chewing, coffee consumption, medications, and acupuncture were included. Early oral feeding reduced postoperative ileus and accelerated bowel function return. The most assessed intervention was chewing gum, which was associated with a median reduction of postoperative ileus by 45% (range, 11%-59%) and shortening of the time to first flatus and time to defecation by a median of 11.9 and 17.7 hours, respectively. Coffee intake showed inconsistent results, with a median shortening of time to flatus and time to defecation by 1.32 and 14.45 hours, respectively. CONCLUSION Early oral feeding, chewing gum, and alvimopan were the most commonly assessed and effective strategies for reducing postoperative ileus after colorectal surgery. Medications used to reduce postoperative ileus included alvimopan, intravenous lidocaine, dexamethasone, probiotics, and oral antibiotics. Intravenous dexamethasone and lidocaine and oral probiotics helped hasten bowel function return. Acupuncture positively impacted the recovery of bowel function.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt. https://twitter.com/dr_samehhany81
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel. https://twitter.com/nirhoresh
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel. https://twitter.com/RachellGefen
| | - Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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Kaveh M, Yeganehzad S, Rabie Ashkezary M, Hesarinejad MA, Todaro A, Nishinari K. Chewing gum base: A comprehensive review of composition, production, and assessment methods: Advances and approaches in biodegradability. J Texture Stud 2023; 54:789-807. [PMID: 37584385 DOI: 10.1111/jtxs.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
The gum base mass is a colloidal system and the main component of chewing gum; which is an inert, non-nutritious, indigestible, and insoluble part of chewing gum, therefore this substance does not dissolve in the mouth when chewed. The gum base plays the most crucial role in determining the mechanical properties, flexibility, and overall quality of chewing gum. Moreover, it acts as a delivery system to transport sweeteners, flavorings, and other ingredients in chewing gum. Despite the massive market for chewing gum and the provision of a list of the main ingredients in gum base by the Code of Federal Regulations and some international organizations, there is a lack of information about chewing gum base and its compositions in the literature. Therefore, the purpose of this review is to present an overview of the characteristics, ingredients and applications, production process, assessment, and modification methods of the gum base along with the advances and approaches in biodegradability. Biodegradability concerns play a promoting role in the research and development of chewing gum and its applications in the food industry, medical and dental sectors. Reviewing previous studies can surely help for faster development of this path.
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Affiliation(s)
- Mona Kaveh
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Samira Yeganehzad
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Mansour Rabie Ashkezary
- Department of Agriculture, Food and Forest Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - Mohammad Ali Hesarinejad
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Aldo Todaro
- Department of Agriculture, Food and Forest Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - Katsuyoshi Nishinari
- Glyn O. Phillips Hydrocolloid Research Centre, School of Food and Biological Engineering, Hubei University of Technology, Wuhan, China
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Ammann Y, Warschkow R, Bischofberger S, Ukegjini K, Tarantino I, Steffen T. Objective estimation of colonic transit time using radiopaque markers in an abdominal X-ray after laparoscopic colorectal resection: secondary analysis of a randomized clinical trial. BJS Open 2023; 7:zrad111. [PMID: 37931231 PMCID: PMC10627524 DOI: 10.1093/bjsopen/zrad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Yanic Ammann
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Rene Warschkow
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Stephan Bischofberger
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Kristjan Ukegjini
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Ignazio Tarantino
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Thomas Steffen
- Department of General, Visceral, Endocrine, and Transplant Surgery, Cantonal Hospital of St Gallen, St Gallen, Switzerland
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Ye W, Dong B, Li G, Zhang Y. The effect of probiotics on surgical outcomes in patients with gastric cancer: a meta-analysis of randomized controlled trials. Front Surg 2023; 10:1254597. [PMID: 37901305 PMCID: PMC10611462 DOI: 10.3389/fsurg.2023.1254597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
The effect of probiotics on postoperative infectious complications and nutritional status in patients with gastric cancer is still controversial, and a comprehensive search and analysis of the current relevant evidence is necessary. Our study aimed to define the effects of probiotics on surgical outcomes in gastric cancer patients undergoing surgery. Up to June 20, 2023, Embase, PubMed, Web of Science, and Cochrane databases were searched for randomized controlled trials of probiotics in gastric cancer patients undergoing surgery. Relative risk (RR) or mean difference (MD) was used to calculate the effect sizes using RevMan 5.3. A total of nine studies reporting on 861 participants were included. Perioperative supplementation with probiotics did not improve weight loss (MD 0.73 kg; 95% CI: -0.56, 2.02) or serum prealbumin levels (MD 9.48 mg/L 95% CI: -3.43, 22.40), but did reduce the incidence of postoperative infectious complications (RR 0.46, 95% CI 0.28, 0.77), shorten the time to first exhaust (MD -11.27 h; 95% CI: -16.83, -5.70), the time to first defecation (MD -15.71 h; 95% CI: -25.62, -5.79), and the length of hospital stay (MD -0.94 days; 95% CI: -1.33, -0.55), and increase serum albumin levels (MD 0.73 g/L; 95% CI: 0.01, 1.46) in gastric cancer patients undergoing surgery. Probiotics are effective in preventing postoperative infectious complications, promoting postoperative recovery, and improving nutritional status in gastric cancer patients undergoing surgery. Our study highlights the importance of probiotics for healthcare systems and offers a potential strategy to improve the prognosis and reduce the medical burden of gastric cancer patients undergoing surgery.
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Affiliation(s)
| | | | | | - Yuqiang Zhang
- Department of General Surgery, People’s Hospital of Rongchang District, Chongqing, China
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Patton ME, Andrews FM, Bogers SH, Wong D, McKenzie HC, Werre SR, Byron CR. Effects of Bit Chewing on Gastric Emptying, Small Intestinal Transit, and Orocecal Transit Times in Clinically Normal Horses. Animals (Basel) 2023; 13:2518. [PMID: 37570326 PMCID: PMC10416828 DOI: 10.3390/ani13152518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Ileus is a common life-threatening problem in horses, and currently available treatments may be ineffective. The purpose of this study was to determine whether bit chewing, a form of sham feeding, decreases the gastric emptying time (GET), small intestinal transit time (SITT), and total orocecal transit time (OCTT) in clinically normal horses in a prospective crossover study. Nine healthy horses were acclimated and fed a standardized diet. Following 24 h of fasting, self-contained video endoscopy capsules and acetaminophen were administered into the stomach via a nasogastric tube. Each horse underwent experimental (bit chewing for 20 min every 6 h) or control (no bit chewing) conditions, with a 3-week minimum washout period between conditions. The horses were enrolled in either part of the study until all video capsules were retrieved and/or 30 days lapsed. The video capsules were recovered from manure, and GET, SITT, and OCTT were determined from a video analysis. Bit chewing significantly decreased OCTT (p = 0.015) compared to the control conditions. Bit chewing decreased GET and SITT, but the differences were not significant. The mean (median) times determined via the video capsule analysis for the bit-chewing conditions were as follows: GET, 2.34 h (2.86 h); SITT, 3.22 h (3.65 h); and OCTT, 5.13 h (6.15 h), and for the control conditions, they were as follows: GET, 3.93 h (5 h); SITT, 3.79 h (4.4 h); and OCTT, 8.02 h (9.92 h). Bit chewing decreased OCTT in healthy horses. Because this segment of the gastrointestinal tract is frequently affected by ileus, bit chewing may be a safe and inexpensive intervention for that condition in horses. Further investigation in clinical patients with ileus is warranted.
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Affiliation(s)
- Molly E. Patton
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA; (M.E.P.); (S.H.B.); (H.C.M.III)
| | - Frank M. Andrews
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA;
| | - Sophie H. Bogers
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA; (M.E.P.); (S.H.B.); (H.C.M.III)
| | - David Wong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1800 Christensen Drive, Ames, IW 50011, USA;
| | - Harold C. McKenzie
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA; (M.E.P.); (S.H.B.); (H.C.M.III)
| | - Stephen R. Werre
- Laboratory for Study Design and Statistical Analysis, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA;
| | - Christopher R. Byron
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA 24061, USA; (M.E.P.); (S.H.B.); (H.C.M.III)
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10
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Chen X, Chang C, Yuan X, Yang J, Li K. Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:4295-4310. [PMID: 36691328 DOI: 10.1111/jocn.16604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. BACKGROUND Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. DESIGN A meta-analysis of randomised controlled trials was performed. NO PATIENT OR PUBLIC CONTRIBUTION This was a meta-analysis involving no people or animals. METHODS The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. TRIAL REGISTRATION PROSPERO CRD42022330223. RESULTS Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p = .13) and gastric fluid volume (p = .25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p = .02), lower incidence of postoperative nausea (p = .0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p = .02). CONCLUSIONS Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. RELEVANCE TO CLINICAL PRACTICE This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.
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Affiliation(s)
- Xinrong Chen
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chengting Chang
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xingzhu Yuan
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ka Li
- West China School of Nursing /West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Nasseri Y, Kasheri E, Oka K, Zhu R, Smiley A, Cohen J, Ellenhorn J, Barnajian M. Does coffee affect bowel recovery following minimally invasive colorectal operations? A three-armed randomized controlled trial. Int J Colorectal Dis 2023; 38:199. [PMID: 37470901 DOI: 10.1007/s00384-023-04494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Previous studies have suggested that coffee may shorten the postoperative ileus period. We sought to evaluate the impact of both coffee and caffeine on shortening the return of postoperative bowel function following minimally invasive colectomy. METHODS This was a single-center, randomized controlled clinical trial conducted in a tertiary hospital. Patients undergoing an elective robotic or laparoscopic small or large bowel operation were included in this study. Patients were randomized into one of three groups: warm water, decaffeinated coffee, and caffeinated coffee. Subjects were assigned to drink a 4-oz cup three times daily starting on postoperative day one. The primary endpoint was time to first bowel movement. Secondary endpoints included time to first flatus, length of hospital stay, and postoperative morbidity. RESULTS A total of 99 patients were included in this study: 31 warm water, 31 decaffeinated coffee, and 37 caffeinated coffee. The groups were similar in age and sex (p = 0.51 and 0.91, respectively). Mean (SD) time to the first bowel movement in days was 2.94 (1.4), 2.58 (1.2), and 2.86 (1.3), respectively (p = 0.53). There were no significant differences observed in postoperative morbidity (p = 0.52) between groups. Multivariate linear regression analysis did not reveal a statistically significant association between any interventions and time to first bowel movement or length of hospital stay. CONCLUSIONS Coffee (caffeinated or decaffeinated) does not expedite the return of bowel function following minimally invasive operation. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT02639728 NCT02639728.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group of Los Angeles, Los Angeles, CA, USA.
- Cedars Sinai Medical Center, CA, 90048, Los Angeles, 8635 West 3rd, St. Ste. 880W, USA.
| | - Eli Kasheri
- Surgery Group of Los Angeles, Los Angeles, CA, USA
| | - Kimberly Oka
- Surgery Group of Los Angeles, Los Angeles, CA, USA
| | - Ruoyan Zhu
- Surgery Group of Los Angeles, Los Angeles, CA, USA
| | | | - Jason Cohen
- Surgery Group of Los Angeles, Los Angeles, CA, USA
- Cedars Sinai Medical Center, CA, 90048, Los Angeles, 8635 West 3rd, St. Ste. 880W, USA
| | - Joshua Ellenhorn
- Surgery Group of Los Angeles, Los Angeles, CA, USA
- Cedars Sinai Medical Center, CA, 90048, Los Angeles, 8635 West 3rd, St. Ste. 880W, USA
| | - Moshe Barnajian
- Surgery Group of Los Angeles, Los Angeles, CA, USA
- Cedars Sinai Medical Center, CA, 90048, Los Angeles, 8635 West 3rd, St. Ste. 880W, USA
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12
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Kilcoyne I. When Things Do Not Go As Planned: Update on Complications and Impact on Outcome. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00014-7. [PMID: 37105780 DOI: 10.1016/j.cveq.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, One Shields Avenue, Davis, CA 95616, USA.
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13
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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14
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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15
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Effects of Gum Chewing on Recovery From Postoperative Ileus: A Randomized Clinical Trail. THE JOURNAL OF NURSING RESEARCH : JNR 2022; 30:e233. [PMID: 35951432 DOI: 10.1097/jnr.0000000000000510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sham feeding with products such as chewing gum has been theorized to decrease the incidence and time to resolution of postoperative ileus. The conflicting findings in the literature on this subject are because in part of the use of mixed study populations, which has led to difficulties in assessing the value of sham feeding in ameliorating this condition. PURPOSE The aim of this study was to evaluate the efficacy of postsurgical gum chewing in restoring normal bowel movement in patients with colorectal cancer who had undergone abdominal surgery for colon resection. METHODS A randomized controlled trial was used to examine the time to first postoperative flatus and defecation. The intervention group ( n = 30) received xylitol chewing gum on the first day after colon resection, one piece of gum for 15 minutes, 3 times daily, until the time to first flatus and defecation. Both the intervention and control groups ( n = 30) received standard postoperative care and were encouraged to walk as soon as possible after surgery. The time to first flatus was reported by patients. RESULTS The time to first flatus and defecation in the intervention group was significantly shorter than that in the control group (39.13 ± 15.66 vs. 52.92 ± 21.97 hours and 54.55 ± 18.90 vs. 77.98 ± 34.59 hours, respectively). However, after controlling for age and surgical duration, only time to first flatus was significantly shorter in the intervention group. Significantly positive correlations were found between time to first flatus and time to first defecation in both groups. CONCLUSIONS/IMPLICATIONS FOR PRACTICE In this study, gum chewing was shown to have a positive effect on the time to first postoperative flatus and defecation. This inexpensive and noninvasive intervention may be recommended to decrease the time to resolution of postsurgical ileus in middle-aged and older patients who have undergone open abdominal surgery for colorectal resection.
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Liao XQ, Li SL, Peng YC, Chen LW, Lin YJ. Effects of chewing gum on gastrointestinal function in patients following spinal surgery: a meta-analysis and systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2536-2546. [PMID: 35852608 DOI: 10.1007/s00586-022-07304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE There are conflicting opinions regarding the efficacy of chewing gum for the recovery of gastrointestinal function in patients following spinal surgery. Thus, we aimed to conduct a systematic review and meta-analysis of existing articles to evaluate the effect of gum-chewing on patients following spinal surgery. METHODS A computer search was used to identify randomised controlled trials (RCTs) involving gum-chewing from eight databases: Cochrane Library, PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WanFang Data. After evaluating the risk of bias for the included studies, we used the Revman 5.3 software to conduct a meta-analysis of the data. RESULTS The study included seven RCTs, with a total of 706 patients. The meta-analysis reported that gum-chewing could shorten the interval between surgery and first bowel movement (mean deviation [MD] = - 23.02; 95% confidence interval [CI]: - 24.67, - 21.38; P < 0.00001), first flatus (MD = - 1.54; 95% CI - 2.48, - 0.60; P = 0.001), and first bowel sounds (MD = - 5.08; 95% CI - 6.02, - 4.15; P < 0.00001). Moreover, there was a significant reduction in postoperative analgesic dosage within 12 h (standardised mean difference [SMD] = - 0.28; 95% CI - 0.52, - 0.05; P = 0.02). However, there were no significant differences between the chewing gum and control groups (P > 0.05) regarding the postoperative nausea score, abdominal pain score, 24- and 48-h analgesic drug dosage, and length of hospital stay. CONCLUSION To a certain extent, masticating gum can promote the recovery of gastrointestinal function and reduce the need for postoperative analgesics in patients following spinal surgery. However, this conclusion is affected by the quantity and quality of the included articles. Therefore, additional high-quality studies are needed to verify these results.
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Affiliation(s)
- Xiao-Qin Liao
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Sai-Lan Li
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yan-Chun Peng
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Liang-Wan Chen
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Yan-Juan Lin
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China.
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17
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Impact of habitual chewing on gut motility via microbiota transition. Sci Rep 2022; 12:13819. [PMID: 35970869 PMCID: PMC9378666 DOI: 10.1038/s41598-022-18095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
The gut environment, including the microbiota and its metabolites and short-chain fatty acids (SCFA), is essential for health maintenance. It is considered that functional recovery treatment for masticatory dysphagia affects the composition of the gut microbiota, indicating that habitual mastication, depending on the hardness of the food, may affect the gut microbiota and environment. However, the impact of chronic powdered diet feeding on the colonic condition and motility remains unclear. Here, we evaluated various colonic features in mice fed with powdered diets for a long-term and a mouse model with masticatory behavior. We observed a decreased abundance of the SCFA-producing bacterial genera in the ceca of the powdered diet-fed mice. Based on the importance of SCFAs in gut immune homeostasis and motility, interestingly, powdered diet feeding also resulted in constipation-like symptoms due to mild colitis, which were ameliorated by the administration of a neutrophil-depleting agent and neutrophil elastase inhibitors. Lastly, the suppressed colonic motility in the powdered diet-fed mice was significantly improved by loading masticatory activity for 2 h. Thus, feeding habits with appropriate masticatory activity and stimulation may play a key role in providing a favorable gut environment based on interactions between the gut microbiota and host immune system.
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18
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An innovative oral management procedure to reduce postoperative complications. JTCVS OPEN 2022; 10:442-453. [PMID: 36004276 PMCID: PMC9390213 DOI: 10.1016/j.xjon.2022.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Abstract
Background Numerous studies have shown that improving oral hygiene contributes to a reduction in the risk of postoperative complications in patients with head and neck cancer, cardiac disease, and esophageal cancer. However, the beneficial standard for oral management procedures during the perioperative period has not yet been established. Therefore, our aim was to determine whether or not their innovative oral management intervention contributed to a reduction in postoperative complications in lung cancer. Methods We performed a retrospective analysis of medical records of patients who underwent lung cancer surgery with lobectomy and pneumonectomy at Kyorin University Hospital. Patients were divided into 2 groups: a perioperative oral management intervention group that underwent lung cancer surgery from April 2016 to March 2018 (n = 164), and a control group without oral management that underwent surgery from April 2014 to March 2016 (n = 199). In particular, our oral management procedure emphasized oral mucosa stimulation to induce saliva discharge as in gum chewing, rather than simply using teeth brushing to reduce oral microbiome. Therefore, our oral management procedure is different from traditional oral care. Results This study demonstrated that our oral management practice was associated with a decline in the occurrence of postoperative pneumonia (odds ratio, 0.184; 95% CI, 0.042-0.571; P = .009), postoperative hospital stay duration (β coefficient, −4.272; 95% CI, −6.390 to −2.155; P < .001) and Clavian-Dindo classification grade II or above (odds ratio, 0.503; 95% CI, 0.298-0.835; P = .009). Conclusions We propose an innovative new strategy using their unique oral management procedure to reduce postoperative complications resulting from pulmonary resection.
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19
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Atkins CS, Tubog TD, Schaffer SK. Chewing Gum After Radical Cystectomy With Urinary Diversion for Recovery of Intestinal Function: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2022; 37:467-473. [PMID: 35272926 DOI: 10.1016/j.jopan.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the efficacy of chewing in the recovery of intestinal function after radical cystectomy. DESIGN Systematic review and meta-analysis. METHODS Following the PRISMA statement, PubMed, CINAHL, Google Scholar, Cochrane Review Database, EMBASE, Scopus, and grey literature were searched for evidence. FINDINGS The analysis included 2 trials with 100 patients. Compared to placebo, chewing gum resulted in faster recovery of bowel function (mean difference [MD], -16.00; 95% confidence interval [CI], -18.67 to -13.32; P < .00001). In addition, chewing gum decreased the time to flatus (MD, -14.81; 95% CI, -22.14 to -7.47; P < .0001), but did not reduced the length of stay (MD, 0.97; 95% CI, -1.23 to 3.18; P = .39) and the incidence of postoperative ileus (risk ratio, 0.67; 95% CI, 0.20-2.23; P = .51). The quality of evidence is low due to imprecision and suspected publication bias. CONCLUSIONS Chewing gum appears to be an inexpensive intervention to improve the return of bowel function in patients undergoing radical cystectomy.
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20
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Prevention and Treatment of Gastrointestinal Morbidity. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Patton ME, Leise BS, Baker RE, Andrews FM. The effects of bit chewing on borborygmi, duodenal motility, and gastrointestinal transit time in clinically normal horses. Vet Surg 2021; 51:88-96. [PMID: 34775623 DOI: 10.1111/vsu.13745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/12/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the influence of bit chewing on gastrointestinal transit in clinically normal horses. STUDY DESIGN Prospective crossover designed study. ANIMALS Six healthy adult horses. METHODS Horses were assigned randomly to treatment (apple flavored bit) and control (no-bit) groups and studied for 2 × 1-week trial periods with a 2-week washout period between trials. Horses were fasted for 24 h and slowly refed over 3 days. The bit was placed for 20 min every 6 h. Duodenal contractions and borborygmi auscultations were evaluated every 12 h, approximately 5 min following bit placement. Gastrointestinal total transit time (GI TTT) was measured by administering 200 colored beads via stomach tube and then collected in the manure until 50% and 80% were recovered. Measured variables were compared using an ANOVA or Wilcoxon signed-rank test and the P value was noted. RESULTS The GI TTT was shortened in the bit chewing group (median: 106.37 h, range: 70-171 h) compared to the no-bit group (median: 170.1 h, range: 149-186 h) (P = .0156) at 80% bead passage (only 4/6 horses passed 80%). Borborygmi (P = .8193), duodenal contractions (P = .2605), and 50% bead passage (P = .0781) showed no differences. CONCLUSION Bit chewing was safe, inexpensive, and well tolerated. Bit chewing shortened GI TTT and might be an adjunct therapy to augment GI TTT. Further clinical studies are warranted. CLINICAL SIGNIFICANCE Ileus is a common complication following equine abdominal surgery with no current consistently successful treatment. Bit chewing may be a simple and inexpensive way to augment progressive GI motility.
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Affiliation(s)
- Molly E Patton
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Britta S Leise
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Rose E Baker
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Frank M Andrews
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
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22
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He H, Ma Y, Zheng Z, Deng X, Zhu J, Wang Y. Early versus delayed oral feeding after gastrectomy for gastric cancer: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104120. [PMID: 34910976 DOI: 10.1016/j.ijnurstu.2021.104120] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early oral feeding has been shown to be safe and effective for most surgeries, while surgeons and nurses are still hesitant to implement it in gastric cancer patients who undergo gastrectomy. OBJECTIVES This review aimed to investigate the safety and feasibility of early versus delayed oral feeding in gastric cancer patients after gastrectomy. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES The literature search was performed in 7 databases from inception to March 7, 2021. REVIEW METHODS Randomized controlled trials that compared the effects of early oral feeding and delayed oral feeding in gastric cancer patients who undergo gastrectomy were included. The primary outcome was hospital days, and secondary outcomes included hospital costs, postoperative complication rates, feeding intolerance rates, annal exhaust time, albumin levels and prealbumin levels. According to the presence of heterogeneity, fixed or random effect meta-analysis was applied. RESULTS Nine trials involving 1087 gastric cancer patients who undergo gastrectomy were pooled in this systemic review and meta-analysis. The results showed that early oral feeding significantly decreased hospital days (mean difference = -1.50, 95% confidence interval = -1.91 to -1.10, P < 0.001) and hospital costs (mean difference = -4.21, 95% confidence interval = -5.00 to -3.42, P < 0.001) compared to delayed oral feeding, while the incidences of postoperative complications (risk ratio = 0.96, 95% confidence interval = 0.72 to 1.26, P = 0.76) and feeding intolerance (risk ratio = 0.95, 95% confidence interval = 0.79 to 1.15, P = 0.62) were comparable between the two groups. In comparison to delayed oral feeding, early oral feeding was associated with shorter annal exhaust time (mean difference = -0.61, 95% confidence interval = -0.81 to -0.40, P < 0.001) and higher levels of albumin (mean difference = 3.77, 95% confidence interval = 2.42 to 5.12, P < 0.001) and prealbumin (mean difference = 18.11, 95% confidence interval = 15.33 to 20.88, P < 0.001). Furthermore, the results of distal gastrectomy subgroup analysis indicated that hospital days were shorter in the early oral feeding group than in the delayed oral feeding group. CONCLUSIONS For gastric cancer patients who undergo gastrectomy, early oral feeding was associated with shorter hospital days and lower hospital costs, but early oral feeding did not increase the incidences of postoperative complications or feeding intolerance. Moreover, early oral feeding also decreased the annal exhaust time but increased the levels of albumin and prealbumin.
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Affiliation(s)
- Haiyan He
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanyuan Ma
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Zhiwei Zheng
- Department of Digestion, The 958st Hospital, Chongqing, China
| | - Xiaolian Deng
- Department of Gastrointestinal Colorectal and Anal Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingci Zhu
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China.
| | - Yaling Wang
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China.
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Urcanoglu OB, Yildiz T. Effects of Gum Chewing on Early Postoperative Recovery After Laparoscopic Cholecystectomy Surgery: a Randomized Controlled Trial. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Khan M, Joyce E, Horn J, Scoville JP, Ravindra V, Menacho ST. Postoperative bowel complications after non-shunt-related neurosurgical procedures: case series and review of the literature. Neurosurg Rev 2021; 45:275-283. [PMID: 34297261 DOI: 10.1007/s10143-021-01609-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Postoperative bowel complications after non-shunt-related neurosurgical procedures are relatively rare. In an effort to identify the primary risk factors, we evaluated postoperative bowel complications in cranial, endovascular, and spinal procedures in neurosurgery patients using our own institutional case series along with a literature review.We identified severe postoperative bowel complications that occurred at our institution after non-shunt-related neurosurgical procedures between July 2016 and December 2018. We also completed a systematic review of PubMed/MEDLINE using search terms related to bowel complications.At our institution, 7 patients (average age 49.7 ± 9.5 years, range 34-60; no apparent sex predilection) had severe postoperative bowel complications after undergoing a total of 10 neurosurgical procedures. Diagnosis was on average 1 week postoperatively (range 5-13 days), and the time between radiographic/clinical diagnosis and either surgery or death was 1.3 ± 1.4 days (range 0-4 days). Bowel perforation occurred in 4 patients. Five of the patients died, 3 as a direct result of the bowel complication. In the literature review, we identified 6487 spine and 66 cranial and/or endovascular bowel complications after neurosurgical procedures.Our case series and literature review demonstrate that severe postoperative bowel complications after non-shunt-related neurosurgical procedures, while rare, carry significant morbidity/mortality despite prompt and aggressive management. These can also happen without direct injury to bowel tissue, instead occurring as sequelae of inflammatory processes, as well as from delayed mobility, extended use of opiate narcotics, and lack of standardized protocols to ensure early bowel movements that likely stems from unfamiliarity with this potentially devastating complication.
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Affiliation(s)
- Majid Khan
- University of Nevado, Reno School of Medicine, Reno, NV, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Jeffrey Horn
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Jonathan P Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Vijay Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA.
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Koch KE, Hahn A, Hart A, Kahl A, Charlton M, Kapadia MR, Hrabe JE, Cromwell JW, Hassan I, Gribovskaja-Rupp I. Male sex, ostomy, infection, and intravenous fluids are associated with increased risk of postoperative ileus in elective colorectal surgery. Surgery 2021; 170:1325-1330. [PMID: 34210525 DOI: 10.1016/j.surg.2021.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Postoperative ileus is a common and costly complication after elective colorectal surgery. Effects of intravenous fluid administration remain controversial, and the effect of ostomy construction has not been fully evaluated. Various restrictive intravenous fluid protocols may adversely affect renal function. We aimed to investigate the impact of intestinal reconstruction and intravenous fluid on ileus and renal function after colorectal resection under an enhanced recovery protocol. METHODS A retrospective study of a prospectively maintained institutional database for a tertiary academic medical center following National Surgical Quality Improvement Program standards was reviewed, analyzing elective colorectal resections performed under enhanced recovery protocol from 2015 to 2018. Postoperative ileus was defined as nasogastric decompression, nil per os >3 days postoperatively, or nasogastric tube insertion. Patients with and without ileus were compared. Intravenous fluid and different anastomoses and ostomies were investigated. Acute kidney injury was a secondary outcome, due to the potential of renal damage with restriction of intravenous fluid volume during and after surgery and controversy in current literature in this matter. RESULTS Postoperative ileus occurred in 18.5% of patients (n = 464). Male sex (odds ratio 1.97, 95% confidence interval 1.12-3.52) and postoperative infection (odds ratio 2.13, 95% confidence interval 1.03-4.35) were associated with ileus. Compared to colorectal anastomosis, ileostomy/ileorectal anastomosis had the highest risk of ileus (odds ratio 4.9, 95% confidence interval 2.33-11.3), colostomy second highest (odds ratio 3.3, 95% confidence interval 1.35-8.39), while ileocolic anastomosis did not significantly differ (odds ratio 2.06, 95% confidence interval 0.69-5.85) on multivariate analysis. Each liter of intravenous fluid within the first 72 hours significantly correlated with postoperative ileus (odds ratio 1.41, 95% confidence interval 1.27-1.59). Rates of acute kidney injury did not differ (P = .18). CONCLUSION Each additional liter of intravenous fluid given in the first 72 hours increased the risk of postoperative ileus 1.4-fold. There is substantially higher risk of ileus with male sex, infection, ileostomy/ileorectal anastomosis, and colostomy. Judicious use of intravenous fluid, as described in our enhanced recovery protocol, is not detrimental for renal function in the setting of normal baseline.
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Affiliation(s)
- Kelsey E Koch
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Amy Hahn
- College of Public Health, University of Iowa, Iowa City, IA
| | - Alexander Hart
- College of Public Health, University of Iowa, Iowa City, IA
| | - Amanda Kahl
- College of Public Health, Iowa Cancer Registry, University of Iowa, Iowa City, IA
| | - Mary Charlton
- College of Public Health, University of Iowa, Iowa City, IA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jennifer E Hrabe
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - John W Cromwell
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
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Comparison of treatment to improve gastrointestinal functions after colorectal surgery within enhanced recovery programmes: a systematic review and meta-analysis. Sci Rep 2021; 11:7423. [PMID: 33795783 PMCID: PMC8016851 DOI: 10.1038/s41598-021-86699-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 02/01/2023] Open
Abstract
Despite a significant improvement with enhanced recovery programmes (ERP), gastro-intestinal (GI) functions that are impaired after colorectal resection and postoperative ileus (POI) remain a significant issue. In the literature, there is little evidence of the distinction between the treatment assessed within or outside ERP. The purpose was to evaluate the efficiency of treatments to reduce POI and improve GI function recovery within ERP. A search was performed in PubMed and Scopus on 20 September 2019. The studies were included if they compared the effect of the administration of a treatment aiming to treat or prevent POI or improve the early functional outcomes of colorectal surgery within an ERP. The main outcome measures were the occurrence of postoperative ileus, time to first flatus and time to first bowel movement. Treatments that were assessed at least three times were included in a meta-analysis. Among the analysed studies, 28 met the eligibility criteria. Six of them focused on chewing-gum and were only randomized controlled trials (RCT) and 8 of them focused on Alvimopan but none of them were RCT. The other measures were assessed in less than 3 studies over RCTs (n = 11) or retrospective studies (n = 2). In the meta-analysis, chewing gum had no significant effect on the endpoints and Alvimopan allowed a significant reduction of the occurrence of POI. Chewing-gum was not effective on GI function recovery in ERP but Alvimopan and the other measures were not sufficiently studies to draw conclusion. Randomised controlled trials are needed.Systematic review registration number CRD42020167339.
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Quiroga-Centeno AC, Jerez-Torra KA, Martin-Mojica PA, Castañeda-Alfonso SA, Castillo-Sánchez ME, Calvo-Corredor OF, Gómez-Ochoa SA. Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta-analysis. World J Surg 2021; 44:1612-1626. [PMID: 31912254 DOI: 10.1007/s00268-019-05366-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) represents a frequent complication following colorectal surgery, affecting approximately 10-15% of these patients. The objective of this study was to evaluate the perioperative risk factors for PPOI development in colorectal surgery. METHODS The present systematic review and meta-analysis was conducted in accordance with the PRISMA Statement. PubMed, EMBASE, SciELO, and LILACS databases were searched, without language or time restrictions, from inception until December 2018. The keywords used were: Ileus, colon, colorectal, sigmoid, rectal, postoperative, postoperatory, surgery, risk, factors. The Newcastle-Ottawa scale and the Jadad scale were used for bias assessment, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS Of the 64 studies included, 42 were evaluated in the meta-analysis, comprising 29,736 patients (51.84% males; mean age 62 years), of whom 2844 (9.56%) developed PPOI. Significant risk factors for PPOI development were: male sex (OR 1.43; 95% CI 1.25-1.63), age (MD 3.17; 95% CI 1.63-4.71), cardiac comorbidities (OR 1.54; 95% CI 1.19-2.00), previous abdominal surgery (OR 1.44; 95% CI 1.19, 1.75), laparotomy (OR 2.47; 95% CI 1.77-3.44), and ostomy creation (OR 1.44; 95% CI 1.04-1.98). Included studies evidenced a moderate heterogeneity. The quality of evidence was regarded as very low-moderate according to the GRADE approach. CONCLUSIONS Multiple factors, including demographic characteristics, past medical history, and surgical approach, may increase the risk of developing PPOI in colorectal surgery patients. The awareness of these will allow a more accurate assessment of PPOI risk in order to take measures to decrease its impact on this population.
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Affiliation(s)
| | | | | | | | | | | | - Sergio Alejandro Gómez-Ochoa
- Member Grupo de Investigación en Cirugía y Especialidades Quirúrgicas (GRICES-UIS), School of Medicine, Health Sciences Faculty, Universidad Industrial de Santander, Street 32 · 29-31, Bucaramanga, Colombia.
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Schwartz J, Gan TJ. Management of postoperative nausea and vomiting in the context of an Enhanced Recovery after Surgery program. Best Pract Res Clin Anaesthesiol 2020; 34:687-700. [PMID: 33288119 DOI: 10.1016/j.bpa.2020.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
The concept of Enhanced Recovery after Surgery (ERAS) emerged at the turn of the millennium and quickly gained footing worldwide leading to the establishment of institutional ERAS protocols and subspecialty guidelines. While the use of postoperative nausea and vomiting (PONV) prophylaxis predates ERAS by a significant extent, the emergence of ERAS amplified the importance of antiemetic prophylaxis in perioperative care and drew attention to the truly multifactorial nature of postoperative gastrointestinal dysfunction. The following discussion will review key paradigms behind PONV prophylaxis and ERAS, highlight the interrelationship between these two endeavors, and then explore subspecialty ERAS guidelines that uniquely influence PONV prophylaxis. Attention will center on the ERAS Society guidelines (ESGs) as the primary representative of current ERAS practice, though many deviations from the guidelines exist within the literature and institutional practices.
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Affiliation(s)
- Jonathon Schwartz
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY 11794-8480, USA.
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY 11794-8480, USA.
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Pak H, Maghsoudi LH, Soltanian A, Gholami F. Surgical complications in colorectal cancer patients. Ann Med Surg (Lond) 2020; 55:13-18. [PMID: 32435475 PMCID: PMC7229272 DOI: 10.1016/j.amsu.2020.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/01/2020] [Accepted: 04/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Advancements in diagnostic and therapeutic sciences have allowed early diagnosis and treatment of cancer. Colorectal cancer is one of the most commonly reported cancers, particularly in elderly patients. METHODS Open and laparoscopic surgeries are used for the removal of the tumor, along with chemotherapy, depending on the stage of cancer. However, colorectal cancer surgery is associated with a great number of complications, that affect the efficacy of the surgery and overall health and survival of the patient. RESULTS Prevalence of these complications have shown discrepancies depending on the condition of the patient and disease and surgical skills of the surgeon. Preoperative evaluation, intraoperative care and postoperative measures can reduce the incidence of these complications. CONCLUSION This review highlights some frequently reported complications associated with colorectal cancer surgery, their risk factors and subsequent therapeutic measures to treat them.
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Affiliation(s)
- Haleh Pak
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Leila Haji Maghsoudi
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Farshid Gholami
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
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30
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Vakharia RM, Naziri Q, Sodhi N, Scuderi GR, Mont MA, Roche MW. Comparison Study of Patient Demographics, Risk Factors, and Lengths of Stay for Postoperative Ileus After Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:1397-1401. [PMID: 31866253 DOI: 10.1016/j.arth.2019.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postoperative ileus is a potential complication after orthopedic surgery, which has not been well studied after total knee arthroplasty (TKA). The aims of this study were to analyze rates of postoperative ileus; patient demographic profiles; in-hospital lengths of stay (LOS); and patient-related risk factors for postoperative ileus after primary TKA. METHODS A query was performed from January 1, 2005 to March 31, 2014 using the Medicare Standard Analytical Files. Patients who underwent primary TKA and developed postoperative ileus within 3 days after their index procedure were identified. Patients who did not develop ileus represented controls. Primary outcomes analyzed and compared included patient demographics, risk factors, and in-hospital LOS. A P value less than .05 was considered statistically significant. RESULTS Ileus patients were older, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (8 vs 6; P < .0001) compared with controls. Male patients (odds ratio [OR], 2.12; P < .0001), patients with preoperative electrolyte/fluid imbalance (OR, 3.40; P < .001), patients older than 70 years (OR, 1.62-2.33; P < .015), and body mass indices greater than 30 kg/m2 (OR, 1.79-2.00; P < .001) were at the greatest risk of developing ileus. In addition, ileus patients had significantly longer in-hospital LOS (5.42 vs 3.22 days; P < .001). CONCLUSION The study demonstrated differences in patient demographics, patient-related risk factors, and an increased in-hospital LOS for ileus patients after primary TKA. The study is important as it can allow orthopedists to properly identify and optimize patients with certain risk factors to potentially mitigate this adverse event from occurring.
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Affiliation(s)
| | - Qais Naziri
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY; Department of Orthopedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
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31
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Sammut R, Trapani J, Deguara J, Ravasi V. The effect of gum chewing on postoperative ileus in open colorectal surgery patients: A review. J Perioper Pract 2020; 31:132-139. [PMID: 32301386 DOI: 10.1177/1750458920917015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative ileus is a common complication of abdominal surgery, leading to prolonged hospital stay and associated costs. Gum chewing may be a safe, cheap intervention to reduce postoperative ileus. METHODS The aim was to investigate the effect of gum chewing on postoperative ileus in open colorectal surgery patients. A literature search was conducted between December 2018 and March 2019 on CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, MEDLINE, Academic Search Complete, PubMed, Scopus and Google Scholar. The keywords used included 'ileus', 'chewing gum', 'mastication' and 'sham feeding'. Papers had to include adults undergoing open colorectal surgery. The studies were appraised using Critical Appraisal Skills Programme tools and the results summarised using a narrative review. RESULTS A total of three systematic reviews and three randomised controlled trials were included in the study. The studies show a significant to highly significant effect of gum chewing on postoperative ileus-related outcomes. The trials however in general utilised a weak design. CONCLUSIONS Gum chewing decreases postoperative ileus following colorectal surgery. More robust trials are required to confirm these findings. Due to the low risk of harm and cost of using gum chewing, its use is recommended even in the interim.
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Affiliation(s)
- Roberta Sammut
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Josef Trapani
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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32
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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33
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Rodrigues Pessoa R, Urkmez A, Kukreja N, Baack Kukreja J. Enhanced recovery after surgery review and urology applications in 2020. BJUI COMPASS 2020; 1:5-14. [PMID: 35474909 PMCID: PMC8988792 DOI: 10.1002/bco2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.
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Affiliation(s)
| | - Ahmet Urkmez
- Department of Urology University of Texas MD Anderson Cancer Center Houston TX USA
| | - Naveen Kukreja
- Department of Anesthesia University of Colorado Aurora CO USA
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34
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Venara A, Bougard M, Mucci S, Lemoult A, Le Naoures P, Darsonval A, Barbieux J, Neunlist M, Hamy AP. Perioperative Transcutaneous Tibial Nerve Stimulation to Reduce Postoperative Ileus After Colorectal Resection: A Pilot Study. Dis Colon Rectum 2018; 61:1080-1088. [PMID: 30086057 DOI: 10.1097/dcr.0000000000001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative ileus involves an inflammatory pathway characterized by an increase of inflammation mediators in the colon wall; this could probably be prevented by sacral nerve neuromodulation. The posterior tibial nerve can be stimulated electrically to mimic neuromodulation. OBJECTIVE The aims of this study were to assess the efficacy of transcutaneous posterior tibial nerve stimulation in reducing the delay in GI motility recovery, to assess the safety of posterior tibial nerve stimulation in a perioperative setting, and to assess the efficacy of posterior tibial nerve stimulation in reducing the occurrence of postoperative ileus. DESIGN This was a preliminary randomized controlled study. SETTINGS This study was conducted in 1 academic hospital in France. PATIENTS Forty patients undergoing an elective colectomy were included and randomly assigned into 2 groups, posterior tibial nerve stimulation or placebo, according to the side of colectomy and the surgical access size. INTERVENTION Perioperative posterior tibial nerve stimulation or placebo was performed 3 times per day according to the randomly assigned group. MAIN OUTCOME MEASURES Delay in GI motility recovery (passage of stool and tolerance of solid food) was measured. RESULTS Of the 40 patients included, 34 were included in the final analysis, in which 2 patients in the placebo group were allocated the incorrect device. The 6 other patients were secondarily excluded because of protocol deviation. In the intention-to-treat analysis, the mean delay in GI motility recovery was 3.6 and 3.11 days (in the placebo and tibial nerve stimulation groups; p = 0.60). Occurrence of postoperative ileus was not significantly higher in the placebo group (35.3% vs 17.6%; p = 0.42). In the per-protocol analysis, we observed the same trends except for the occurrence of postoperative ileus, which was significantly higher in the placebo group (p = 0.045). Tolerance to posterior tibial nerve stimulation was good, and all of the patients completed the protocol. LIMITATIONS The amplitude of stimulation is set according to patient sensation, so some patients could have been aware of their group. In addition there were some inherent limitations because of the preliminary nature of the study and several deviations from the protocol. CONCLUSIONS Posterior tibial nerve stimulation was safe in a perioperative setting and had a potential effect on GI motility recovery. The results of this study will be useful for sample size calculations in a larger prospective randomized trial. See Video Abstract at http://links.lww.com/DCR/A708.
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Affiliation(s)
| | - Marie Bougard
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Stéphanie Mucci
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Annabelle Lemoult
- L'Université Nantes Angers Le Mans, University of Nantes, Nantes, France.,Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Paul Le Naoures
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Astrid Darsonval
- Department of Pharmacy, Centre Hospitalier Universitaire Angers, Angers, France
| | - Julien Barbieux
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Michel Neunlist
- Unité Mixte de Recherche Institut National de la Santé et de la Recherche Médicale U1235, University of Nantes, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, Nantes, France.,L'Université Nantes Angers Le Mans, University of Nantes, Nantes, France
| | - Antoine P Hamy
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
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Abstract
PURPOSE OF REVIEW Postoperative ileus (POI) is an important contributor to postoperative morbidity. However, postoperative outcomes have improved by enhanced recovery after surgery (ERAS) programs. Enteral nutrition is an essential part of ERAS and many studies suggest a therapeutic effect of nutrition on POI. RECENT FINDINGS Early postoperative enteral nutrition has been shown to reduce various complications, including POI, although studies are heterogeneous. Experimental studies suggest that composition and timing of the enteral feed is important for the potential beneficial effects: lipid-enriched nutrition given just before, during, and directly after surgery was most effective in reducing POI in an experimental setting. In a clinical study in patients undergoing advanced rectal cancer surgery, direct start of enteral tube feeding reduced POI. Conversely, perioperative lipid-enriched enteral nutrition did not reduce POI in patients undergoing colorectal surgery with an ERAS protocol. SUMMARY POI is common and remains an important determinant of postoperative recovery following colorectal surgery. Nutrition is a potential therapeutic means to reduce POI. Timing and composition of the enteral feed have been shown to be essential for the beneficial effects of enteral nutrition in an experimental setup. However perioperative lipid-enriched nutrition does not reduce POI in patients undergoing colorectal surgery with an ERAS protocol.
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Affiliation(s)
- Boudewijn J J Smeets
- Department of Surgery, Catharina Hospital, Eindhoven
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Buijs MM, Kobaek-Larsen M, Kaalby L, Baatrup G. Can coffee or chewing gum decrease transit times in Colon capsule endoscopy? A randomized controlled trial. BMC Gastroenterol 2018; 18:95. [PMID: 29940864 PMCID: PMC6020226 DOI: 10.1186/s12876-018-0824-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A high rate of complete colon capsule endoscopy (CCE) investigations is required for a more widespread use of CCE. The objective of this study was to assess if coffee or chewing gum can increase excretion of the colon capsule within battery life time (excretion rate). METHODS One hundred eighty six screening participants with a positive immunochemical fecal occult blood test were included in this single-centre randomized controlled trial with blinding of the investigators to the randomization. Participants received instant coffee, chewing gum or nothing in addition to the standard bowel preparation. RESULTS The intention was to include 57 participants in the coffee group, 61 in the chewing gum group and 60 in the control group, on 8 participants data were missing. A total of 165 participants were included in a per protocol analysis. Exclusion was due to not receiving the allocated intervention (8 coffee, 4 chewing gum) and technical failure of the capsule (1 coffee). The excretion rate was 58% in the coffee group (n = 48), 63% in the chewing gum group (n = 57) and 55% in the control group (n = 60, p > 0.2). Transit times were similar in all groups. The excretion rate was low in participants who had transit times over 10 h (14%). A strong correlation was found between adequate cleansing and excretion of the capsule. There were no serious adverse events related to the interventions or CCE investigations. CONCLUSIONS Chewing gum and coffee did not improve excretion rate in this study. An effect of chewing gum could not be proven, possibly due to sample size. Since chewing gum might improve excretion rates, is cheap and has no known side effects, it needs to be considered in future bowel preparation trials for CCE. TRIAL REGISTRATION NCT02303756 , registered on December 1st 2014.
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Affiliation(s)
- Maria Magdalena Buijs
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark. .,Department of Surgery, Odense University Hospital, Baagøes Allé 15, Forskningshus, 5700, Svendborg, Denmark.
| | - Morten Kobaek-Larsen
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark
| | - Lasse Kaalby
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, Winsløwsparken 19, 3rd floor, 5000, Odense, Denmark.,Department of Surgery, Odense University Hospital, Baagøes Allé 15, Forskningshus, 5700, Svendborg, Denmark
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37
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Lambrichts DPV, Lange JF. Response to 'Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomised controlled trial'. Colorectal Dis 2018; 20:450. [PMID: 29323446 DOI: 10.1111/codi.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/30/2017] [Indexed: 02/08/2023]
Affiliation(s)
- D P V Lambrichts
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Surgery, Havenziekenhuis Rotterdam, Rotterdam, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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