Prospective comparison of return of bowel function after left versus right colectomy.
BACKGROUND
Passage of flatus and stool represents a key milestone in recovery after colonic resections. Colorectal surgeons may hold varied expectations regarding recovery rates after left- versus right-sided colectomies, but there is currently little evidence to inform post-operative care. This study prospectively compared gut function recovery after left- versus right-sided resections.


METHODS
Prospective data were analysed from 94 consecutive patients undergoing elective colorectal resections with primary anastomosis at Auckland City Hospital. Patients having ileostomies were excluded. Primary analysis compared time to first bowel motion between left- versus right-sided resections, excluding patients who developed prolonged post-operative ileus, while secondary analyses compared length of stay, rates of prolonged ileus and other complications.


RESULTS
Analysis included 42 patients with left-sided and 52 with right-sided resections. No significant differences were observed for complications (P = 0.1), length of stay (P = 0.9) or development of prolonged ileus (P = 0.2). Rate of return of bowel function was faster in patients after left-sided resections (median 2.5 versus 4 days; P = 0.03 by Log-rank (Mantel-Cox) test), when patients with prolonged post-operative ileus were excluded. An association was also identified between length of bowel resected and time to recovery of bowel function for right-sided (P = 0.02) but not left-sided resections (P = 0.9).


CONCLUSIONS
This study shows that for patients who do not progress to prolonged ileus, those with left-sided resections experience faster return of bowel function when compared with those having right-sided resections. The reason for this finding is currently unknown and deserves further attention.
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Lance
L
Yuan
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Gregory
G
O'Grady
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Tony
T
Milne
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Rebekah
R
Jaung
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Ryash
R
Vather
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Ian P
IP
Bissett
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D005414:Flatulence; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome
enhanced recovery; ileus; post-operative complications; post-operative recovery