Gastrointestinal Myoelectric and Clinical Patterns of Recovery After Laparotomy

Abstract

The objective of this study was to define the patterns of myoelectric activity that occur throughout the gastrointestinal tract during normal recovery from laparotomy. Electrodes were placed on the stomach, jejunum, and transverse colon of 44 patients undergoing laparotomy. Basal electric rhythms in all areas showed no changes in frequency after operation (up to 1 month). Gastric spike wave activity showed a gradient of increasing activity from fundus to antrum. Antral spike activity was unchanged during the study. Jejunal spike activity was present in the earliest recordings and occurred in 45.9% +/- 3.5% to 59.9% +/- 5.5% of slow waves. Recovery of normal colon discrete and continuous electric response activity occurred on postoperative day 5.9 +/- 1.5. Bowel sounds returned on day 2.4 +/- 0.5 and passage of flatus and stool occurred on day 5.1 +/- 0.2. The myoelectric parameters measured are not absolutely predictive of uneventful recovery from postoperative ileus but they are, as a group, more informative than any currently available clinical criteria.

Avaliação dos resultados de intervenção após mudanças realizadas nos cuidados peri-operatórios em pacientes submetidos a operações abdominais eletivas

“…Na comparação entre os dois períodos, observou-se no período pós-intervenção uma diminuição de 2,5 horas no tempo de jejum pré-operatório (14 horas vs. 10 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] horas; p=0,0002). Considerando apenas operações porte II, houve queda de 1,5 horas no tempo de jejum pré-operatório (12 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] horas vs 13 [5][6][7][8][9][10][11][12][13][14]…”

“…Essa prática não só pode contribuir com a piora do estado nutricional de pacientes previamente desnutridos, como aumenta o tempo de internação hospitalar 11 . Por outro lado, pacientes submetidos a grandes intervenções e alimentados precocemente apresentam melhor oxigenação da mucosa intestinal 12 , diminuição da resposta orgânica e do número de complicações no pós-operatório [13][14][15] , assim como, redução do tempo de dismotilidade intestinal 16,17 . Apesar de importantes avanços nos cuidados cirúrgicos, complicações pós-operatórias são ainda de grande preocupação.…”

Does disorder of gastrointestinal motility affect food intake in the post-surgical patient?

“…1977) and man (Ingram & Catchpole, 1981;Waldenhausen et al 1990). It is likely, therefore, that this disturbed propagation plays an important role in delaying gastric emptying post-operatively.…”

Postoperative Ileus: Pathophysiology and Treatment

“…It requires a conscious patient who is comfortable reporting its occurrence to the investigator. Also, there is some question as to the correlation between flatus and bowel movements (Waldhausen, et al, 1990). Bowel movements are seemingly the most reliable end point.…”