Postoperative Motility of the Small Intestine: A Study with Endoradiosondes

Dahlgren, S; Selking, Örjan

doi:10.1517/03009734000000029

Cited by 20 publications

(5 citation statements)

References 9 publications

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“…Since then, studies have focused on the duration, intensity, and time course of postsurgical dysmotility in different species using various techniques, including clinical evaluation,2'32 radiology, [13][14][15] intraluminal pressure recordings, strain gauges,5 and in vivo myoelectric activity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Manipulation of the Gut Elicits an Intestinal Muscularis Inflammatory Response Resulting in Postsurgical Ileus

Kalff

Schraut²,

Simmons³

et al. 1998

Annals of Surgery

496

448

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ObjectiveTo investigate the pathophysiologic mechanisms that lead to ileus after abdominal surgery. Summary Background DataThe common supposition is that more invasive operations are associated with a more extensive ileus. The cellular mechanisms of postsurgical ileus remain elusive, and few studies have addressed the mechanisms. MethodsRats were subjected to incremental degrees of surgical manipulation: laparotomy, eventration, "running," and compression of the bowel. On postsurgical days 1 and 7, muscularis infiltrates were characterized immunohistochemically. Circular muscle activity was assessed using mechanical and intracellular recording techniques in vitro. ResultsSurgical manipulation caused an increase in resident phagocytes that stained for the activation marker lymphocyte function-associated antigen (LFA-1). Incremental degrees of manipulation also caused a progressive increase in neutrophil infiltration and a decrease in bethanechol-stimulated contractions. Compression also caused an increase in other leukocytes: macrophages, monocytes, dendritic cells, T cells, natural killer cells, and mast cells. ConclusionThe data support the hypothesis that the degree of gut paralysis to cholinergic stimulation is directly proportional to the degree of trauma, the activation of resident gut muscularis phagocytes, and the extent of cellular infiltration. Therefore, postsurgical ileus may be a result of an inflammatory response to minimal trauma in which the resident macrophages, activated by physical forces, set an inflammatory response into motion, leading to muscle dysfunction.Postsurgical ileus is a persistent feature of abdominal surgery that can lead to significant morbidity and mortality rates. 2 Ileus is generally accepted as a normal response to abdominal surgery. Besides causing significant patient discomfort (respiratory compromise, abdominal distention, nausea, emesis, and pain) and more serious problems (e.g., acute gastric dilatation, aspiration), ileus prolongs the hospital stay, delays early enteral nutrition, and increases medical costs. Despite the widespread presence of this problem, little is known about the underlying pathogenesis.

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Section: Discussionmentioning

confidence: 99%

Surgical Manipulation of the Gut Elicits an Intestinal Muscularis Inflammatory Response Resulting in Postsurgical Ileus

Kalff

Schraut²,

Simmons³

et al. 1998

Annals of Surgery

496

448

View full text Add to dashboard Cite

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“…However, others have described normal intestinal motility after most abdominal operations, including cholecystectomy and transection and anastomosis of the small bowel [3][4][5]. These conflicting results may be related to different animals and techniques employed, such as clinical evaluation, balloon kymography, radiographic techniques, and intraluminal pressure measurements [6,7].…”

mentioning

confidence: 99%

Gastrointestinal myoelectric activity following abdominal operations in the opossum

Coelho¹,

Gouma²,

Moody³

et al. 1985

World j. surg.

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Gastrointestinal myoelectric activity of the opossum, both in fasting and fed states, was studied after abdominal operations. Five different procedures were performed: a 5‐min, a 1‐hour, and a 3‐hour laparotomy with intestinal handling, enteroenterostomy, and gastrojejunostomy. Electromyographic recordings from the stomach, duodenum, jejunum, ileum, and sphincter of Oddi were obtained from unanesthetized animals. A normal fasting pattern after abdominal operations was observed from immediately after surgery to the fifth postoperative day and depended on the type and duration of the surgical procedure. A fed pattern did not occur in the experiments in which food was instilled before the appearance of the myoelectric migrating complex. A normal fed pattern was observed after the myoelectric migrating complex appearance in all but 2 experiments, one of which occurred in an animal with an intra‐abdominal abscess.

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“…Hierbei wurden verschiedene Tierspezies und Untersuchungsmethoden benutzt, wie z. B. die klinische Beurteilung [22], radiologische Techniken [6,23], intraluminale Druckaufzeichnung [2], manometrische Verfahren mit Druckund Spannungsmessungen [7] und myoelektrische in vitro Techniken [24 ± 26]. Die Ergebnisse dieser Untersuchungen waren häufig widersprüchlich, konnten die Existenz der muskulären Dysfunktion teilweise nicht nachweisen und den Zeitverlauf der funktionellen Störung nicht korrekt definieren [27,28].…”

Section: Pathomechanismenunclassified

“…Obwohl es intuitiv aufgrund der klinischen Erfahrung durchaus plausibel erscheint, dass ein stärkeres Ausmaû an operativem Trauma auch zu einer ausgeprägteren Darmatonie führt, haben einige Studien gezeigt, dass Operationsdauer und -ausmaû nicht mit der Dauer der postoperativen Darmatonie korrelieren [25,29]. Dahlgren und Selking fanden eine relevante Minderung der Darmmotilität erst nach extensiven abdominellen Eingriffen [23]. In tierexperimentellen Studien zeigten Bueno et al, dass die Manipulation des Darmes im Vergleich zur einfachen Laparotomie und isolierten Anästhesie zu einer stärkeren Funktionseinschränkung der glatten Darmmuskulatur führt [24].…”

Section: Pathomechanismenunclassified