title: Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection.
abstract: BACKGROUND
  Routine laxatives may expedite gastrointestinal recovery and early tolerance of food within an enhanced recovery after surgery (ERAS) programme. Combined with carbohydrate loading and oral nutritional supplements (ONS), it may further enhance recovery of gastrointestinal function and promote earlier overall recovery.
  
  
  METHODS
  Seventy-four patients undergoing liver resection were randomized in a two-by-two factorial design to receive either postoperative magnesium hydroxide as a laxative, preoperative carbohydrate loading and postoperative ONS, their combination or a control group. Patients were managed within an ERAS programme of care. The primary outcome measure was time to first passage of stool. Secondary outcome measures were gastric emptying, postoperative oral calorie intake, time to functional recovery and length of hospital stay.
  
  
  RESULTS
  Sixty-eight patients completed the trial. The laxative group had a significantly reduced time to passage of stool: median (interquartile range) 4 (3-5) versus 5 (4-6) days (P = 0.034). The ONS group showed a trend towards a shorter time to passage of stool (P = 0.076) but there was no evidence of interaction in patients randomized to the combination regimen. Median length of hospital stay was 6 (4-7) days. There were no differences in secondary outcomes between groups.
  
  
  CONCLUSIONS
  Within an ERAS protocol for patients undergoing liver resection, routine postoperative laxatives result in an earlier first passage of stool but the overall rate of recovery is unaltered.
authors.affiliation: Clinical and Surgical Sciences (Surgery), Royal Infirmary, Edinburgh, UK. paul.hendry@ed.ac.uk
authors.forename: P O
authors.initials: PO
authors.lastname: Hendry
authors.forename: R M
authors.initials: RM
authors.lastname: van Dam
authors.forename: S F F W
authors.initials: SF
authors.lastname: Bukkems
authors.forename: D W
authors.initials: DW
authors.lastname: McKeown
authors.forename: R W
authors.initials: RW
authors.lastname: Parks
authors.forename: T
authors.initials: T
authors.lastname: Preston
authors.forename: C H C
authors.initials: CH
authors.lastname: Dejong
authors.forename: O J
authors.initials: OJ
authors.lastname: Garden
authors.forename: K C H
authors.initials: KC
authors.lastname: Fearon
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage*; D007902:Length of Stay; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008276:Magnesium Hydroxide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D020127:Recovery of Function
chemical_list: D054368:Laxatives; D008276:Magnesium Hydroxide