Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
Faculty of Science, University of Bath, Bath, UK.
Colorectal Dis. 2020 Jan;22(1):86-94. doi: 10.1111/codi.14788. Epub 2019 Oct 3.
Despite implementation of enhanced recovery after surgery (ERAS) and laparoscopic techniques, postoperative ileus (POI) remains frequent after colorectal surgery, impacting the patient, their recovery and health-care resources. Presently there are no tests that reliably predict or enable early POI diagnosis. Volatile organic compounds (VC) are products of human and microbiota cellular metabolism and we hypothesised that a detectable alteration occurs in POI.
This was a prospective observational study of patients undergoing laparoscopic colorectal resection within an established ERAS programme. Standardized end-expiratory breath sampling was performed on the morning of surgery and on the first three postoperative mornings. The concentrations of VCs commonly found in intestinal gas were analysed using selected ion flow tube mass spectrometry and GastroCH ECK®. Feasibility data, bowel preparation, postoperative oral intake, POI and 30-day morbidity were recorded.
Of the 75 potentially eligible patients, 58 (77%) agreed to participate. Per-protocol breath sampling was successfully completed in 94%. There were no analytical failures. Baseline and postoperative concentrations of VCs were broadly comparable and were not altered by bowel preparation or postoperative oral intake. POI developed in 14 (29%) patients. Preoperative ammonia concentration was higher in patients who developed POI [830 parts per billion (ppb) vs 510 ppb, P = 0.027]. There was an increase in the concentration of acetic acid detected on day 2 in patients who developed POI (99 ppb vs 171 ppb, P = 0.021).
Repeated VC breath sampling and analysis is feasible in the perioperative setting. An elevated ammonia concentration on the morning of surgery may be a potential predictor of POI.
尽管实施了手术后强化康复（ERAS）和腹腔镜技术，术后肠梗阻（POI）仍然是结直肠手术后常见的并发症，影响患者的康复和医疗资源。目前，没有可靠的测试可以预测或早期诊断 POI。挥发性有机化合物（VOC）是人体和微生物细胞代谢的产物，我们假设在 POI 中会发生可检测的改变。
这是一项在既定 ERAS 计划内接受腹腔镜结直肠切除术的患者的前瞻性观察研究。在手术当天早上和术后的前三个早晨进行标准化呼气末呼吸采样。使用选择离子流管质谱和 GastroCH ECK®分析肠气中常见的 VC 浓度。记录可行性数据、肠道准备、术后口服摄入、POI 和 30 天发病率。
在 75 名潜在合格的患者中，有 58 名（77%）同意参与。按方案进行呼吸采样的成功率为 94%。没有分析失败。基线和术后 VC 浓度大致相当，不受肠道准备或术后口服摄入的影响。14 名（29%）患者发生 POI。发生 POI 的患者术前氨浓度较高[830 个部分/十亿（ppb）比 510 ppb，P=0.027]。发生 POI 的患者第 2 天检测到的乙酸浓度升高（99 ppb 比 171 ppb，P=0.021）。
围手术期重复 VC 呼吸采样和分析是可行的。手术当天早上氨浓度升高可能是 POI 的潜在预测指标。
