University of Aberdeen Medical School, Aberdeen, UK.
Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Int J Surg. 2022 Jul;103:106651. doi: 10.1016/j.ijsu.2022.106651. Epub 2022 May 24.
Ileus (delayed return of bowel function after surgery) is one of the highest priority research questions in modern day colorectal practice. Current Enhanced Recovery After Surgery (ERAS) guidance either does not include a specific recommendation for volume of postoperative oral fluids/foodstuffs or suggests ad-lib fluids. It is unclear if the volume of intake affects ileus rates. This systematic review aimed to determine the optimal fluid volume for patients to consume day one after elective colorectal surgery.
The literature was searched across seven databases, September 23, 2020. Randomised controlled trials of adults undergoing elective colorectal surgery, comparing oral intake postoperatively were eligible for inclusion. Two blinded reviewers assessed papers with disagreements resolved by a third independent reviewer. Main outcomes were 'resolution of postoperative ileus' and 'length of hospital stay'. Secondary outcomes included vomiting, mortality and complications.
Of 2175 screened papers, eight were eligible for inclusion. All studies gave a clear liquid diet postoperatively. The comparison groups followed a traditional nil-by-mouth approach. All studies showed a minor reduction in postoperative ileus and hospital stay in the intervention group, but we are unable to determine the optimal postoperative oral fluid volume. The low number and poor quality of studies was a significant limitation. None of the trials were conducted within an ERAS protocol: only 883 patients were included in total.
From the current literature it is unclear how postoperative oral fluid volume intake affects gastrointestinal function and ileus in elective colorectal surgical patients. This remains an important area for further research.
术后肠麻痹（手术后肠道功能恢复延迟）是现代结直肠实践中最重要的研究问题之一。目前，增强术后恢复（ERAS）指南要么没有针对术后口服液体/食物量的具体建议，要么建议随意补液。目前尚不清楚摄入量的多少会影响肠麻痹的发生率。本系统评价旨在确定择期结直肠手术后患者第一天摄入的最佳液体量。
研究人员于 2020 年 9 月 23 日在七个数据库中检索文献。符合纳入标准的研究为成人择期结直肠手术，比较术后口服摄入的随机对照试验。两名盲法审查员评估论文，意见不一致时由第三名独立审查员解决。主要结局为“术后肠麻痹的缓解”和“住院时间”。次要结局包括呕吐、死亡率和并发症。
在筛选出的 2175 篇论文中，有 8 篇符合纳入标准。所有研究均在术后给予清液饮食。对照组采用传统的禁食方法。所有研究均显示干预组术后肠麻痹和住院时间略有减少，但我们无法确定最佳术后口服液体量。研究数量少且质量差是一个显著的局限性。没有一项试验是在 ERAS 方案内进行的：总共只有 883 名患者被纳入。
根据目前的文献，术后口服液体量的摄入如何影响择期结直肠手术患者的胃肠道功能和肠麻痹仍不清楚。这仍然是一个需要进一步研究的重要领域。
