Gastrointestinal transit after laparoscopic versus open colonic resection.
BACKGROUND
Multimodal rehabilitation with epidural analgesia, early oral nutrition and mobilization, and laxative use has decreased the duration of ileus after colonic surgery to about 2 days, as compared with the usual 3 to 5 days of rehabilitation required after open surgery and the slightly shorter time required with laparoscopic surgery. Gastrointestinal transit after colonic resection with laparoscopy or laparotomy was assessed.


METHODS
In this study, 32 patients randomized to laparoscopic or open colonic resection received 4 MBq of 111indium diethylenetriamine pentaacetic acid, a tracer, at the end of surgery. Images of the abdomen were obtained 24 and 48 h postoperatively. An opaque abdominal dressing blinded care personnel and patients to the procedure.


RESULTS
Defecation occurred on median day 2 postoperatively in both groups. At 48 h postoperatively, 53% of the tracer was excreted by patients in the laparoscopic group, as compared with 26% in the open group ( p > 0.05).


CONCLUSIONS
Postoperative ileus and gastrointestinal transit normalized within 48 h after colonic resection in the patients who received multimodal rehabilitation. No significant difference was observed between the patients who underwent the laparoscopic procedure and those who underwent the open procedure.
Basse
L
L
Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark. LBas@novonordisk.com
Madsen
J L
JL
Billesbølle
P
P
Bardram
L
L
Kehlet
H
H
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000534:rehabilitation; D003082:Colectomy / Q000009:adverse effects* / Q000534:rehabilitation; D012809:Colon, Sigmoid / Q000601:surgery*; D003672:Defecation; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D045823:Ileus / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D004369:Pentetic Acid / Q000493:pharmacokinetics; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D016037:Single-Blind Method
D019275:Radiopharmaceuticals; D004369:Pentetic Acid