How long for gastrointestinal recovery following small bowel, right, or left colonic resection with anastomosis in a full fast-track recovery protocol?

CONTEXT

Patients undergoing bowel resection with anastomosis experience postoperative impaired gastrointestinal motility, sometimes leading to symptoms such as nausea, vomiting, bloating, delayed passage of flatus and stools, and inability to tolerate solid food. We determined the times for recovery of gastrointestinal motility (in minutes) following intestinal resection with anastomosis.

METHODS

We used data from the MATRAC randomized clinical trial, a comparison between outcomes of a standard ERAS group and an ERAS plus massage group. 36 patients were randomized, 35 retained in the study (standard ERAS n = 16; ERAS plus massage n = 19).

RESULTS

Solid foods are tolerated after a median of about 3 h after small bowel resection, and medians of approximately 16 and 14 h after right and left colon resection, respectively. The first flatus appeared approximately 16, 44 and 17 h after resection of the small bowel, right colon and left colon, respectively. In other words, first flatus is expected during the first postoperative day following small bowel and left colon resection, and during the second postoperative day following right colon resection. The first stool appears approximately 36, 70 and 46 h after small bowel, right colon and left colon resection, respectively.

CONCLUSION

We found that the shortest recovery time was observed following small bowel resection, and the longest in patients who underwent right colectomy. The same evolution was observed for the resumption of flatus, defecation and solid food intake, taken separately.