Venara Aurélien, Alfonsi Pascal, Cotte Eddy, Loriau Jérôme, Hamel Jean-François, Slim Karem
Department of Visceral Surgery, CHU of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, 1, rue Gaston Veil, 44035, Nantes, France.
Int J Colorectal Dis. 2019 Jan;34(1):71-83. doi: 10.1007/s00384-018-3165-9. Epub 2018 Oct 6.
Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery.
This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required.
Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30-6.28), urinary retention (OR = 1.75; 95% CI: 1.05-2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04-9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15-8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74-8.88 and OR = 5.76; 95% CI: 3.56-10.62).
Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.
在强化康复计划（ERP）中，术后肠梗阻（POI）的发生率有所下降。此外，诸如吻合口漏（AL）等腹腔内并发症（IAC）通常出现较晚。目的是明确POI与术后发生的其他并发症之间的联系。
由法语区术后强化康复小组对一个前瞻性数据库进行了这项回顾性分析。如果术后3天内胃肠功能未恢复或需要更换鼻胃管，则认为存在POI。
参与研究的2773例患者中，2335例（83.8%）因癌症、良性肿瘤、炎症性肠病和憩室病接受了结直肠切除术。在这2335例患者中，309例（13.2%）发生了POI，其中185例（59.9%）为继发性POI。校正已知危险因素（男性、造口需求、右半结肠切除术、手术时间、剖腹手术和转为开放手术）后，POI与腹部并发症（比值比[OR]=4.55；95%置信区间[CI]：3.30-6.28）、尿潴留（OR=1.75；95%CI：1.05-2.92）、肺部并发症（OR=4.55；95%CI：2.04-9.97）和心脏并发症（OR=3.01；95%CI：1.15-8.02）相关。在腹部并发症中，AL和IAC与POI的相关性最强（分别为OR=5.97；95%CI：3.74-8.88和OR=5.76；95%CI：3.56-10.62）。
在ERP中，不应将POI视为常见情况。POI与IAC之间存在显著联系。由于POI是一种早期出现的临床体征，其发生应提醒医生，并促使他们考虑进行CT扫描以调查其他潜在的发病情况。
