Current Strategies for Preventing post-op ileus

Interesting. My Dad did not get any bowel prep/cleansing before his radical cystectomy. I remember the shock that caused here. Looks like it might not have been that big of a deal. He did have the dreaded NG tube.

I found another really good article on reducing post-op ileus.

I wonder if this thread should be moved to Invasive? Since everyone who gets an RC has a post-operative ileus, and its just matter of "for how long", maybe I should have posted it there to begin with.

Here is the article link: www.medpagetoday.com/pdf/MEVH04/pages.cfm?section=02-overview.cfm

While I pasted the conclusion paragraph, this is a good read and quite comprehensive in what has been found to work and what has not.

OK. I signed up for Science Direct and I can see the summary but it still wants me to buy the full report for $31.50.

THe difference is, once I'm signed in, it automatically adds the article to my "Shopping Cart".
Before I had a login, it asked me to sign in or click the purchase link.

Everyone can see the abstract:

But below the abstract are links to the details behind it:

Clicking any of those takes you to the Shopping Cart page to get payment info.
Would be nice to see the post-operative information for details.....

Oh well.....
If anybody has a secret way of seeing this info without having to buy it, please send me a PM with the info.

Mike

I know Rudy did have the NG tube but they removed it. I remember getting the NG tube on and off and it wasn't fun. One time they stuck it down in my lung.

I will call his wife today and tell her about the gum.
They did have him do some walking in place and they are encouraging it. I will follow up on that today though.

I just don't want him to have the same situation as I did so I'm looking for everything I can find.

I was able to read the part you posted, but the details of the study are listed as links and if click on the links, it comes up and says I have to sign in to get it or pay money. I thought I signed up before (for free) but I'll have to experiment with some user names and passwords to see if I can figure out what I used.

Thanks,
Mike

hmmm..Mike try to register with science direct. I was able to and have guest access. Anyway they propose
" Major abdominal surgery, and also radical cystectomy, is followed by a delayed return of bowel function attributable to postoperative ileus (POI), which, in addition, stands out as one of the most frequent complications that causes increased length of stay (LOS). Some variability exists in the definition of POI since time to return of peristalsis and time to first passage of flatus, which are commonly referred to as indicators of bowel activity, have their own weaknesses, observer dependent and time dependent, among other variables. A number of causes have been recognized to induce or maintain the condition of ileus. Some among them are part of the perioperative period. The practices of mechanical bowel preparation (MBP) and of fasting before surgery have been challenged and can be safely abandoned. The perception of pain is an acknowledged promoter of POI; therefore, providing complete pain control constitutes the rationale in favor of administering anesthesia and analgesia combined, both in the form of concurrent general and epidural anesthesia (i.e., at the thoracic level, T9, T11), and represents the mainstay of intraoperative measures. Hypovolemia is also associated with an increased risk of POI. The use of nasogastric tubing (NGT) has been associated with increased pulmonary complications; moreover, bowel resection can be performed safely without postoperative NGT. Early postoperative provision of artificial nutrients has shown beneficial effects, both in the form of total parenteral and enteral nutrition "
Thats part of it anyway. I'm not so sure in the hands of a less experienced surgeon this would necessarily work. I do know places like Indiana U Medical do not use the NG tube and the use of the epidural is becoming more mainstream...sure wish i would have had it. Thats the one thing they did not manage well at all at the Cleveland Clinic..pain. But hey...a pack of gum sure works for me!
Pat

Couldn't read the details of the first one because it costs $31.50 to read it if not a member and I'm not a member. The summary was interesting though. If bowel preparation (in my case it was mag citrate) doesn't help, then I wonder why pretty much everyone still does it.

Second one is interesting as I was actually wondering (while driving down to the hospital to see Rudy today)if gum chewing would hasten the process. It seems quite logical that the act of chewing would stimulate other parts of the digestive system through natural processes.

I bet using a spoon (even with nothing on it) would also help. Therapists use a spoon with stroke patients before giving them anything as it stimulates saliva and other digestive functions.

Mike