• 중환자간호학회지
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• 제14권1호
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• pp.28-39
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• 2021

Purpose : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. Methods : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematological-related factors. Results : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

• 대한정형외과학회지
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• 제56권4호
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• pp.357-360
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• 2021

수술 후 장폐색(postoperative ileus, POI)은 복부나 대장 수술 후에 발생빈도가 높지만 하지 수술 후에는 드문 것으로 알려져 있다. 저자들은 슬관절 인공관절 전치환술 이후 4일째부터 증상이 시작된 POI로 사망한 81세 환자를 경험하였고, 이에 대한 위험 요인과 진단, 예방법 및 치료에 대해 문헌 고찰하여 보고하고자 한다.

• The Korean Journal of Physiology and Pharmacology
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• 제25권6호
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• pp.507-515
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• 2021

Postoperative ileus (POI), a symptom that occurs after abdominal surgery, reduces gastrointestinal motility. Although its mechanism is unclear, POI symptoms are known to be caused by inflammation 6 to 72 h after surgery. As proton pump inhibitors exhibit protective effect against acute inflammation, the purpose of this study was to determine the effect of ilaprazole on a POI rat model. POI was induced in rats by abdominal surgery. Rats were divided into six groups: control: normal rat + 0.5% CMC-Na, vehicle: POI rat + 0.5% CMC-Na, mosapride: POI rat + mosapride 2 mg/kg, ilaprazole 1 mg/kg: POI rat + ilaprazole 1 mg/kg, ilaprazole 3 mg/kg: POI rat + ilaprazole 3 mg/kg, and ilaprazole 10 mg/kg: POI rat + ilaprazole 10 mg/kg. Gastrointestinal motility was confirmed by measuring gastric emptying (GE) and gastrointestinal transit (GIT). In the small intestine, inflammation was confirmed by measuring TNF-α and IL-1β; oxidative stress was confirmed by SOD, GSH, and MDA levels; and histological changes were observed by H&E staining. Based on the findings, GE and GIT were decreased in the vehicle group and improved in the ilaprazole 10 mg/kg group. In the ilaprazole 10 mg/kg group, TNF-α and IL-1β levels were decreased, SOD and GSH levels were increased, and MDA levels were decreased. Histological damage was also reduced in the ilaprazole-treated groups. These findings suggest that ilaprazole prevents the decrease in gastrointestinal motility, a major symptom of postoperative ileus, and reduces inflammation and oxidative stress.

• Journal of Chest Surgery
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• 제26권6호
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• pp.492-495
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• 1993

We experienced one case of surgical treatment of abdominal aortic aneurysm using retroperitoneal approach. The transperitoneal route has been the standard surgical approach for elective and emergency treatment of aneurysmal or occlusive disease. Among its cited advantages for aortic reconstruction are familarity with the exposure, easy access to the infrarenal aorta and iliac vessels, possibility of simultaneous inspection of the intra-abdominal viscera, and speed of opening and closure.Despite the proved versatility of the transperitoneal approach, it is commonly associated with prolonged ileus, increased third space fluid loss, and significant pulmonary complications. The retroperitoneal approach, on the other hand, has many advantages; excellent exposure for the repair of juxtarenal or suprarenal abdominal aortic aneurysms and visceral vessel occlusive disease, fewer postoperative complications, decreased postoperative third-space fluid losses from intraoperative evaporation and ileus, and improved postoperative pulmonary function. Atherosclerosis was most common cause of abdominal aortic aneurysm. Dacron graft[18mm] was replaced successfully.Postoperative course was uneventful and he was discharged in good condition.

• Archives of Pharmacal Research
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• 제25권6호
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• pp.978-983
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• 2002

Small intestinal transit (SIT) has often been regarded as an index of pathophysiological state of postoperative ileus (PI) in rats. The reliability of SIT as an index of PI was examined in the present study. PI was induced via abdominal surgery (i.e., laparotomy with evisceration and manipulation) in rats. For one group of PI-induced rats, SIT of a charcoal test meal was measured. When necessary, the physical state (i.e., severity and site of distension) of the gastrointestinal (GI) tract in each rat was visually examined. For another group of PI-induced rats, abdominal X-ray radiographs were obtained after introducing the barium sulfate suspension. The abdomen was then opened and the physical state of the GI tract was visually examined. The SIT was decreased in most of the PI-induced rats, and the GI distension was observed, with substantial intersubject variations, in all of the PI-induced rats. However, no linear relationship was evident between the SIT and the severity of GI distension (e.g., at 20 h after PI induction). Instead, the severity and site of GI distension could be monitored by the X-ray radiology. Therefore, the use of SIT as an index of PI should be substantially limited.

• Journal of Gastric Cancer
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• 제17권1호
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• pp.11-20
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• 2017

Purpose: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. Materials and Methods: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. Results: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. Conclusions: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.

• 대한한방내과학회지
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• 제43권4호
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• pp.625-642
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• 2022

목적: 본 연구는 위암 수술 후 장마비의 한의학적 치료 효과를 평가하기 위해 수행하였다. 방법: 2007년 1월 1일부터 2022년 5월 11일까지 출판된 연구들을 6개의 데이터베이스를 통해 수집하였다. 수술 후 한의학적 치료를 받은 위암 환자를 장마비 관련 지표들을 통해 관찰한 연구들을 선정하였다. 결과: 한약, 침, 뜸, 전기혈위자극, 이혈요법, 족삼리혈의 약물 주입을 수술 후 장마비 치료법으로 사용한 27편의 연구를 선정하였다. 한약, 한약과 침 병용요법, 침, 뜸, 전기혈위자극, 이혈요법, 족삼리혈의 네오스티그민 주입 치료군에서 수술 후 첫 가스 배출까지의 시간이 감소하였고 (p<0.00001), 수술 후 첫 배변까지의 시간이 한약. 한약과 침 병용요법, 침, 뜸, 전기혈위자극, 이혈요법, 족삼리혈의 네오스티그민 주입 치료군에서 유의미하게 감소하였다 (p<0.00001). 심각한 이상반응은 나타나지 않았다. 결론: 한의학적 치료는 위절제술 후 위암 환자에게 수술 후 장마비의 예방과 치료법으로 활용될 수 있으며 수술 후 장마비 치료의 임상적 효과를 명확히 하기 위해 후속 연구가 필요하다.

• 임상간호연구
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• 제24권1호
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• pp.85-93
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• 2018

Purpose: This study aim to determine the effect of chewing gum on the reduction of postoperative ileus and recovery after surgery. Methods: The study was conducted as a randomized controlled trial among 82 patients who underwent spine surgery between May 2015 and October 2015. Patients in experimental group chewed sugarless gum 3 times daily for 30 minutes each time until POD 5. Abdominal discomfort, the first defecation, and CAS score (Constipation Assessment Scale) were monitored. Results: After the experiment, abdominal discomfort was significantly decreased in the experimental group compared to that of the control group (F=2.46, p=.044). However, the first defecation occurred on postoperative hour 69.6 in the chewing gum group and on hour 60.2 in the control group (t=-1.63, p=.107). CAS was significantly decreased in the experimental group compared to that of the control group (F=3.51, p=.012). Conclusion: Chewing gum is expected to help patient recover after surgery as safe nurse intervention which can reduce abdominal discomfort and constipation during early postoperative days after spine surgery.

• Neonatal Medicine
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• 제25권1호
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• pp.37-43
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• 2018

Purpose: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. Methods: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight <1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. Results: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9-34.3 weeks) and 893 g (range, 610-1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3-11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was $2.8{\pm}1.5hours$ (range, 1-6 hours). The time until radiographic improvement was $2.8{\pm}3.4days$ (range, 1-14 days) after the procedure. Conclusion: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.

• 한국간담췌외과학회지
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• 제28권1호
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• pp.80-91
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• 2024

Backgrounds/Aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.