Comparison of treatment to improve gastrointestinal functions after colorectal surgery within enhanced recovery programmes: a systematic review and meta-analysis

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.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…With concomitant opioid treatment, alvimopan use may be associated with shorter times to tolerance of a soft diet, return of gastrointestinal function, and decreased LOS. However, no randomized clinical or cost-effectiveness trials have validated these findings in ERAS ® patients [ 58 , 59 , 60 , 61 ], and other safer, less costly agents exist, such as naloxegol and naldemedine [ 62 , 63 ]. Nevertheless, a 5-month retrospective pilot study to reduce alvimopan use after GI function recovery successfully eliminated over two-thirds of postoperative doses through pharmacist recommendation to discontinue [ 64 ].…”

A prospective study of specimen eversion to lateral rectum and valgus resection for low rectal cancer

“…Currently, the incidence of colorectal cancer is increasing, and most patients know little about postoperative recovery, which leads to a series of negative emotions after surgery. Several studies have shown that NOSES and postoperative rehabilitation treatment can promote the early recovery of patients ( 22 , 23 ). This study showed that the SAS and SDS scores and postoperative rehabilitation indexes of patients in the NOSES group were better than those in the LAP group.…”

Effect of Postoperative Coffee Consumption on Postoperative Ileus after Abdominal Surgery: An Updated Systematic Review and Meta-Analysis

“…In the case of cesarean section, the impact of coffee on LOS after cesarean section may be small because the hospital stay is short to begin with [48,49]. In the case of colorectal surgery, coffee had a relatively weak effect on POI, which may be due to other factors related to POI, such as postoperative exercise and nutrition [35,50].…”