medigraphic.com
Asociación Mexicana de Gastroenterología

2007, Number 3

<< Back Next >>

Rev Gastroenterol Mex 2007; 72 (3)

Usefulness of peristalsis, flatulence and evacuation for predicting oral route tolerance in patients subjected to major abdominal surgery

Hernández-Hernández B, Figueroa-Gallaga L, Sánchez-Castrillo C, Belmonte-Montes C

Language: Spanish
References: 22
Page: 207-213
PDF size: 56.85 Kb.


ABSTRACT

Objective: to evaluate the usefulness of bowel sounds, flatus and bowel movement presence to predict tolerance of oral intake in patients following major abdominal surgery. Background data: nutrition is one of the most important factors in the management of postoperative care. The early oral intake has shown to contribute to a faster recovery. Tradicionally the beginning of postoperative feeding after major abdominal surgery is delayed until bowel sounds, flatus and/or bowel movement are present although there is no enough medical evidence for their usefulness. Methods: we studied 88 patients following major abdominal surgery. We registered the presence of bowel sounds, flatus and bowel movement each 24 hours in the postoperative period. We analized the relationship between the presence of these signs and the ability to tolerate oral intake. Predictive values, sensitivity, specificity and ROC curves were calculated. Results: results shown that bowel sounds have an aceptable sensibility but a very low specificity to predict the ability to tolerate oral intake. Unlike bowel sounds, bowel movents shown a low sensibility and a high specificity. Flatus turned out to have and intermediate sensitivity and specificity in the prediction of tolerance of oral feeding. Conclusions: in this study any of these signs were shown as a reliable indicator for begining oral feeding because they have a moderate to low usefulness.


REFERENCES

  1. Silk DB, Gow NM. Postoperative starvation after gastrointestinal surgery. Early feeding is beneficial. BMJ 2001; 323: 761-2.

  2. Nygren J, Thoerell A, Ljungqvist O. New developments facilitating nutritional intake after gastrointestinal surgery. Curr Opin Clin Nutr Metab Care 2003; 5: 593-7.

  3. DiFronzo LA, Yamin N, Patel K, O’Conell T. Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg 2003; 197: 747-52.

  4. Aihara H, Kawamura Y, Konishi F. Reduced medical cost achieved after elective oncological colorectal surgery by early feeding and fewer scheduled examinations. J Gastroenterol 2003; 38: 747-50.

  5. Steed HL, Capstick V, Flood C, et al. A randomized controll trial of early versus traditional postoperative oral intake after major abdominal gynecologyc surgery. Am J Obstet Gynecol 2002; 186: 861-5.

  6. Kehlet H, Büchler M, Beart R, et al. Care after colonic operation- is it evidence-based results from multimodal survey in Europe and the United States. J Am Coll Surg 2006; 202: 45-54.

  7. Kehlet H, Holte K. Review of postoperative ileus. Am J Surg 2001; 182: 3s-10s.

  8. Camberos A, Cymerman J, DiFronzo A, O’Conell T. The effect of cisapride on the success of early feeding alter elective open colon resection. Am Surg 2002; 68: 1093-6.

  9. Brozovich M, Read TE, Andujar JE, et al. Bowel sounds, flatus and bowel movement do not correlate with tolerance of oral intake following major abdominal surgery. Program Guide And Abstracts of American Society of Colon and Rectal Surgeons. Annual Meeting 2005: 179.

  10. Delaney CP, Senagore AJ, Viscusi E, et al. Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg 2006; 191: (3).

  11. Resnick J, Greenwald D, Brandi L. Delayed gastric emptying and postoperative ileus after nongastric abdominal surgery: Part I. Am J Gastroent 1997; 92(5).

  12. Cutler-González D, Arellano-Urrutia J. Solución de glucosa, insulina y potasio en el tratamiento de íleo postoperatorio. Observación clínica preliminar. Cirujano General 2001: 23: 296-300.

  13. Gan T. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006; 102: 1884-98.

  14. Apfel C, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology 1999: 91(3).

  15. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, et al. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obst Gynecol 2006; 194: 95-9.

  16. Roberts G, Bekker T, Carlsen H, et al. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg 2005; 101: 1343-8.

  17. Apfel C, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand 2002; 46: 921-8.

  18. Nelson R. Systematic review of prophylactic nasogastric descompression alter abdominal operations. Br J Surg 2005; 92: 673-80.

  19. Asao T, Kuwano H, Nakamura J, et al. Gum chewing enlaces early recovery from postoperative ileus alter laparoscopic colectomy. J Am Coll Surg 2002; 195: 30-2.

  20. Schmidt W. Alvimopan* (ADL 8-2698) Is a novel peripheral opioid antagonist? Am J Surg 2001; 182: 27S-38S.

  21. Wolff B, Michelassi F, Gerkin T, et al. Alvimopan, a novel, peripherally ating µ opioid antagonist. Ann Surg 2004; 240: 728-35.

  22. Bates J, Foss J, Murphy D. Are peripheral opioid antagonist the solution to opioid side effects? Anesth Analg 2004; 98: 116-22.




2020     |     www.medigraphic.com