Chaouch Mohamed Ali, Daghmouri Mohamed Aziz, Lahdheri Abdallah, Hussain Mohammad Iqbal, Nasri Salsabil, Gouader Amine, Noomen Faouzi, Oweira Hani
Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir.
Department of Anesthesia and Intensive Care, Saint-Louis Hospital AP-HP, University of Paris.
Ann Med Surg (Lond). 2023 Aug 1;85(9):4501-4508. doi: 10.1097/MS9.0000000000001099. eCollection 2023 Sep.
Postoperative ileus (PI) after colorectal surgery is a common surgical problem. This systematic review aimed to investigate the available data in the literature to reduce the PI in the area of colorectal surgery out of the enhanced recovery after surgery principles, referring to published randomized controlled trials (RCTs) and meta-analyses, and to provide recommendations according to the Oxford Centre for Evidence-Based Medicine. The authors conducted bibliographic research on 1 December 2022. The authors retained meta-analyses and RCTs. The authors concluded that when we combined colonic mechanical preparation with oral antibiotic decontamination, the authors found a significant reduction in PI. The open approach was associated with a higher PI rate. The robotic and laparoscopic approaches had similar PI rates. Low ligation of the inferior mesenteric artery presented a PI similar to that of high ligation of the inferior mesenteric artery. There was no difference between the isoperistaltic and antiperistaltic anastomoses or between the intracorporeal and extracorporeal anastomoses. This study summarized the available data in the literature, including meta-analyses and RCTs. For a higher level of evidence, additional multicenter RCTs and meta-analyses of RCTs remain necessary.
结直肠手术后的术后肠梗阻(PI)是一个常见的外科问题。本系统评价旨在调查文献中的现有数据,以根据术后加速康复原则,在结直肠手术领域减少PI,参考已发表的随机对照试验(RCT)和荟萃分析,并根据牛津循证医学中心提供建议。作者于2022年12月1日进行了文献研究。作者纳入了荟萃分析和RCT。作者得出结论,当我们将结肠机械准备与口服抗生素去污相结合时,发现PI显著降低。开放手术方式与较高的PI发生率相关。机器人手术和腹腔镜手术方式的PI发生率相似。肠系膜下动脉低位结扎的PI发生率与肠系膜下动脉高位结扎相似。顺蠕动吻合和逆蠕动吻合之间或体内吻合和体外吻合之间没有差异。本研究总结了文献中的现有数据,包括荟萃分析和RCT。为了获得更高水平的证据,仍需要更多的多中心RCT和RCT的荟萃分析。