Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol

Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol

Kiyasu Y, Tsunoda A, Ohta T, Kusanagi H. Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol. Surg today. 2016 Aug;46(8):895-900.

What is already known:

Early oral feeding after surgery has become one of the key elements of ERAS protocols facilitating earlier hospital discharge. Historically laparoscopic ventral rectopexy as a treatment for rectal prolapse has been associated with a median length of stay of 3-6 days. This single centre study aimed to look at the degree of gastric ileus recovery by the postoperative evening using an ERAS protocol.

What this paper adds:

This study looked at the use of gastric ultrasound to evaluate the pyloric area as a surrogate for identifying gastric ileus. Scans were performed both pre and post-surgery, before and after ingestion of a standardised carbohydrate solution. They report that gastric ileus had resolved in most patients within 5 hours postoperatively and 90% of patients were discharged on the day following surgery having met full discharge criteria. They acknowledge that this is a small study of 40 patients, and it is unclear whether the ERAS protocol is responsible for the reduced length of stay and resolution of gastric ileus.

This study provides further evidence to support early oral feeding as part of ERAS protocols. Their full ERAS protocol was published however the use of NG tubes and thoracic epidurals for laparoscopic cases appears at odds with current ERAS guidelines.

Katie Wimble, Guildford. @wimble_katie