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Bowel function recovery after laparoscopic transverse colectomy within an ERAS program: a comparison to right and left colectomy

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Abstract

Background

It is known that functional recovery of the bowel is slower after right colectomy (RC) compared to left colectomy (LC), but very little has been reported on transverse colectomy (TC).

Objectives

The aim of this study was to compare the clinical and early functional outcomes of TC, a more infrequent operation, to RC, and LC for colorectal cancer.

Methods

Between December 2011 and December 2017, all patients undergoing elective colon resection in our institution were treated according to a standardized ERAS protocol and entered in a prospective database. We included in the study patients undergoing laparoscopic TC, RC, or LC for cancer with curative intent. The primary endpoint was prolonged postoperative ileus (PPOI), defined as need to insert a nasogastric tube, or refractory nausea VAS > 4 on or after the third postoperative day. Secondary endpoints were postoperative morbidity and length of hospital stay (LoS).

Results

Out of 286 patients, 126 met the inclusion criteria: 20 underwent TC, 65 RC, and 41 LC. Patients in LC group were younger than in TC and RC groups; other baseline demographics were similar. PPOI was observed in 5 (25%), 26 (40%), and 10 (24%) patients in TC, RC, and LC groups, respectively (p = 0.417). In single group comparisons, the incidence of PPOI in the TC group was significantly lower in comparison to the RC group (OR for RC: 4.255, 95% CI 1.092–16.667, p = 0.037) and similar to the LC group. No significant differences in terms of postoperative complications or LoS stay were observed.

Conclusion

The incidence of PPOI after segmental laparoscopic colectomy for cancer within an ERAS program appears as infrequent in TC as in LC and lower than after RC. It may be reasonable to consider a slower oral intake after RC, as it represents an independent predictor of PPOI.

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Acknowledgments

We acknowledge Prof. Pietro Majno-Hurst for the advice and revision of the manuscript.

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Contributions

Drs. Raffaello Roesel and Francesco Mongelli contributed equally to this work.

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Correspondence to Raffaello Roesel.

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The authors declare that they have no conflict of interest.

Statement of ethics

The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Swiss Institutional Review Board (Project-ID 2019 00942/CE 3483) without the need of written consent from the patients included. The study was conducted according to the STROBE criteria (http://strobe-statement.org/).

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Roesel, R., Mongelli, F., Ajani, C. et al. Bowel function recovery after laparoscopic transverse colectomy within an ERAS program: a comparison to right and left colectomy. Langenbecks Arch Surg 406, 1563–1570 (2021). https://doi.org/10.1007/s00423-021-02082-3

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