Can postoperative coffee perk up recovery time after colon surgery?

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Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 1,983 words
Lexile Measure: 1400L

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Author(s): Sascha A Müller 1 , Nuh N Rahbari 2 , Bruno M Schmied 3 , Markus W Büchler 4

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bowel movement; bowel paralysis; coffee; ileus

Postoperative ileus is an inevitable multifactorial adverse consequence of surgical procedures and may be defined as the delayed return of physiological coordinated electromotor bowel function after major surgery. Despite a number of advances in perioperative care and surgical techniques, postoperative ileus remains one of the most common challenges in surgery. Up to 40% of patients undergoing laparotomy experience postoperative ileus [1] . This process is usually self-limiting, inhibition of small bowel motility is transient, and the stomach recovers within 24-48 h, whereas colonic function takes 48-72 h to return [2,3] . The clinical symptoms include the absence of flatus and feces transit, and abdominal distension associated with pain, nausea and vomiting [4] . This common phenomenon is clinically important as it contributes to patient discomfort, prolonged hospitalization and increased healthcare costs. Sarawate and colleagues reported that hospital stay was on average 3 days longer for patients with postoperative ileus than for those without, leading to increased costs of US$4000-9000 per hospital stay for abdominal operations [5] . The annual costs caused by postoperative ileus have been estimated to account for US$1.28 billion in the USA [6] . The mechanisms involved in postoperative ileus are multifactorial, and include inhibitory sympathetic input, release of hormones, neurotransmitters and other mediators as well as the effects of analgesics and surgical techniques [3,7] . Treatment may be required, including nasogastric tube decompression, fluid and electrolyte replacement and analgesia. Because of the significant implications of ileus after colectomy, surgeons have devised strategies in an attempt to minimize postoperative ileus. Multimodal approaches used to treat postoperative ileus include the use of laparoscopy to minimize surgical trauma, early feeding and mobilization, avoidance of nasogastric tubes, use of thoracic epidural analgesia and restrictive fluid management. Furthermore, unspecific pharmacologic agents such as water-soluble contrast (gastrografin), specific agents such as alvimopan and a selective µ-receptor opioid antagonist have been suggested [8,9] . Thoracic epidural analgesia has been shown to accelerate the return of bowel function by 1-2 days and to reduce the need for opiates compared with systemic opioids alone [10] . An alternative approach to stimulate bowel function in the postoperative period following partial colectomy is sham feeding in the form of gum chewing. In five such trials in patients undergoing colonic resection, gum-chewing shortened mean time to flatus by 20 h and time to first bowel movement by 29 h, but made no significant differences in length of hospital stay [11] . Asao et al . found earlier return of bowel function and a trend towards earlier hospital discharge in patients who chewed gum after laparoscopic colectomy [12] . Gum is postulated to activate the cephalic-vagal reflex, which is usually enhanced by food, and to increase the production of gastrointestinal hormones associated with bowel motility [12] . However, the management of patients with postoperative ileus varies widely between institutions, and valid scientific evidence for effective therapies is lacking.

In a small group of volunteers...

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Gale Document Number: GALE|A316900818