Gastrointestinal Motility After Digestive Surgery

Abstract

Gastrointestinal (GI) motility dysfunction is a common complication of any abdominal surgical procedure. During fasting, the upper GI tract undergoes a cyclic change in motor activity, called the interdigestive migrating motor contraction (IMC). The IMC is divided into four phases, with phase III having the most characteristic activity. After digestive surgery, GI motility dysfunction shows a lack of a fed response, less phase II activity, more frequent phase III activity of the IMC, and some phase III activity migrating orally. Postoperative symptoms have been related to motor disturbances, such as interrupted or retrograde phase III or low postprandial activity. The causes of GI disorder are autonomic nervous dysfunction and GI hormone disruptions. The administration of a motilin agonist can induce earlier phase III contractions in the stomach after pancreatoduodenectomy. For nervous dysfunction, an inhibitory sympathetic reflux is likely to be important in postoperative motility disorders. Until recently, treatment for gut dysmotility has consisted of nasogastric suction, intravenous fluids, and observation; however, more effective treatment methods are being reported. Recent discoveries have the potential to decrease postoperative gut dysmotility remarkably after surgery.

Abdominal Surgery Affects Small Bowel Transit Time and Completeness of Capsule Endoscopy

“…There are several possible reasons for this, including the long retention time of the capsule in the stomach [10,17] and delayed small bowel transit [18]. Patients who have undergone abdominal surgery frequently show delayed gastrointestinal transit, and even ileus, for a long time after the abdominal surgery [19,20]. The pathogenesis of postoperative intestinal dysmotility is multifactorial and includes the formation of peritoneal adhesions [21], but the precise mechanism is unclear.…”

Postoperative ileus: mechanisms and future directions for research

“…Indeed, this theory has been examined in a murine model of small bowel resection, which described acute disruptions to interstitial cell of Cajal (ICC) networks, slow waves and phasic contractions . Preliminary observations to a similar effect have also been made in other animals, and a human study that investigated distal colonic motility after resection …”

Effects of autonomic nerve stimulation on colorectal motility in rats

“…Such problems may occur spontaneously or after childbirth, hysterectomy and colorectal surgery. Postoperative functional disorders in colorectal motility and defecation such as frequent and irregular evacuation, sensory disorders, and fecal incontinence are closely related to autonomic nerve injury 1–4. The autonomic nervous system can be divided into parasympathetic and sympathetic components.…”

“…Postoperative functional disorders in colorectal motility and defecation such as frequent and irregular evacuation, sensory disorders, and fecal incontinence are closely related to autonomic nerve injury. [1][2][3][4] The autonomic nervous system can be divided into parasympathetic and sympathetic components. Parasympathetic, general visceral efferent innervation of the large bowel is derived from the dorsal motor nucleus of vagi (DMV) and the sacral parasympathetic nucleus.…”