title: The effect of alvimopan on recovery after laparoscopic segmental colectomy.
abstract: BACKGROUND
  Alvimopan, a peripherally acting μ-opioid receptor antagonist, was recently approved for the reduction of postoperative ileus after open colectomy. No data are available regarding the use of alvimopan following laparoscopic segmental colectomy.
  
  
  OBJECTIVE
  This study was designed to evaluate the effectiveness of alvimopan in patients undergoing laparoscopic segmental colectomy.
  
  
  METHODS
  A retrospective review of segmental laparoscopic colectomy was conducted in a population of patients using an accelerated postcolectomy care pathway. Patients that received alvimopan were identified from an institutional review board-approved database and matched with nonalvimopan patients for age, sex, procedure, and diagnosis. Patients with a diverting ileostomy or with contraindications for alvimopam were excluded.
  
  
  RESULTS
  One hundred patients undergoing laparoscopic colectomy received alvimopan perioperatively and were matched with a similar group of nonalvimopan patients. Although patients on alvimopan were significantly less likely to develop postoperative ileus (4% vs 12%; P = .04), there was no difference in length of hospital stay (3.63 days in the alvimopan group vs 3.78 in the nonalvimopan group; P = .84) or 30-day readmission rate (4.0% vs 4.2%; P = .95).
  
  
  CONCLUSIONS
  As the cost of providing health care continues to increase, reductions in perioperative complications and hospital stay are important to hospital efficiency and patient care. Alvimopan effectively reduces the incidence of postoperative ileus in patients undergoing open colectomy; however, hospital stay and readmission rates were not altered in this laparoscopic group. Further study is required before alvimopan can be routinely used in patients undergoing laparoscopic colectomy.
authors.affiliation: General Surgery Residency Program, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5047, USA.
authors.forename: Izi D
authors.initials: ID
authors.lastname: Obokhare
authors.forename: Bradley
authors.initials: B
authors.lastname: Champagne
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Stein
authors.forename: David
authors.initials: D
authors.lastname: Krpata
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan