Abstract：
OBJECTIVE: The recovery of gastrointestinal function and postoperative ileus are the leading goals for clinicians following surgery for adhesive small bowel obstruction. While enhanced recovery programs may improve recovery, their feasibility in emergency surgery has not yet been proven. We sought to assess the incidence of postoperative ileus in patients following surgery for ASBO and the feasibility of enhanced recovery programs, including their benefits in the recovery of gastrointestinal functions and reducing the length of hospitalization.
METHODS: This prospective study includes the first 50 patients surgically treated for ASBO between June 2021 and November 2022. Their surgery was performed either as an emergency procedure or after a short course of medical treatment. The main aim was to compare the observed rate of postoperative ileus with a theoretical rate, set at 40%. The study protocol was registered in clinicaltrials.gov under the number NCT04929275.
RESULTS: Among the 50 patients included in this study, it reported postoperative ileus in 16%, which is significantly lower than the hypothetical rate of 40% (p = 0.0004). The median compliance with enhanced recovery programs was 75% (95%CI: 70.1-79.9). The lowest item observed was the TAP block (26%) and the highest observed items were preoperative counselling and compliance with analgesic protocols (100%). The overall morbidity was 26.5%, but severe morbidity (Dindo-Clavien > 3) was observed in only 3 patients (6%). Severe morbidity was not related with the ERP.
CONCLUSIONS: Enhanced recovery programs are feasible and safe in adhesive small bowel obstruction surgery patients and could improve the recovery of gastrointestinal functions.
BACKGROUND: NCT04929275. WHAT DOES THE STUDY CONTRIBUTE TO THE FIELD?: Perioperative management of adhesive small bowel obstruction (ASBO) surgery needs to be improved in order to reduce morbidity. Enhanced recovery programs (ERP) are both feasible and safe following urgent surgery for ASBO. ERPs may improve the recovery of gastrointestinal (GI) functions.
METHODS: This prospective study includes the first 50 patients surgically treated for ASBO between June 2021 and November 2022. Their surgery was performed either as an emergency procedure or after a short course of medical treatment. The main aim was to compare the observed rate of postoperative ileus with a theoretical rate, set at 40%. The study protocol was registered in clinicaltrials.gov under the number NCT04929275.
RESULTS: Among the 50 patients included in this study, it reported postoperative ileus in 16%, which is significantly lower than the hypothetical rate of 40% (p = 0.0004). The median compliance with enhanced recovery programs was 75% (95%CI: 70.1-79.9). The lowest item observed was the TAP block (26%) and the highest observed items were preoperative counselling and compliance with analgesic protocols (100%). The overall morbidity was 26.5%, but severe morbidity (Dindo-Clavien > 3) was observed in only 3 patients (6%). Severe morbidity was not related with the ERP.
CONCLUSIONS: Enhanced recovery programs are feasible and safe in adhesive small bowel obstruction surgery patients and could improve the recovery of gastrointestinal functions.
BACKGROUND: NCT04929275. WHAT DOES THE STUDY CONTRIBUTE TO THE FIELD?: Perioperative management of adhesive small bowel obstruction (ASBO) surgery needs to be improved in order to reduce morbidity. Enhanced recovery programs (ERP) are both feasible and safe following urgent surgery for ASBO. ERPs may improve the recovery of gastrointestinal (GI) functions.
摘要：
目的：胃肠功能的恢复和术后肠梗阻是粘连性小肠梗阻手术后临床医生的首要目标。虽然增强的恢复计划可以改善恢复，它们在急诊手术中的可行性尚未得到证实。我们试图评估ASBO手术后患者术后肠梗阻的发生率和强化康复计划的可行性。包括它们在恢复胃肠功能和减少住院时间方面的益处。
方法：这项前瞻性研究包括2021年6月至2022年11月接受ASBO手术治疗的前50名患者。他们的手术是作为急诊手术或经过短期治疗后进行的。主要目的是将观察到的术后肠梗阻率与理论率进行比较，设定在40%。该研究方案在clinicaltrials.gov中注册，编号为NCT04929275。
结果：本研究纳入的50例患者中，它报告了16%的术后肠梗阻，显著低于假设的40%(p=0.0004)。强化恢复计划的中位依从性为75%(95CI:70.1-79.9)。观察到的最低项目是TAP阻滞（26％），观察到的最高项目是术前咨询和对镇痛方案的依从性（100％）。总发病率为26.5%，但是仅在3例患者中观察到严重的发病率(Dindo-Clavien>3)(6%)。严重发病率与ERP无关。
结论：强化康复方案在粘连性小肠梗阻手术患者中是可行和安全的，可促进胃肠功能的恢复。
背景：NCT04929275。这项研究对该领域有什么帮助？：需要改进粘连性小肠梗阻（ASBO）手术的围手术期管理，以降低发病率。在ASBO紧急手术后，增强恢复计划（ERP）既可行又安全。ERPs可以改善胃肠道（GI）功能的恢复。
方法：这项前瞻性研究包括2021年6月至2022年11月接受ASBO手术治疗的前50名患者。他们的手术是作为急诊手术或经过短期治疗后进行的。主要目的是将观察到的术后肠梗阻率与理论率进行比较，设定在40%。该研究方案在clinicaltrials.gov中注册，编号为NCT04929275。
结果：本研究纳入的50例患者中，它报告了16%的术后肠梗阻，显著低于假设的40%(p=0.0004)。强化恢复计划的中位依从性为75%(95CI:70.1-79.9)。观察到的最低项目是TAP阻滞（26％），观察到的最高项目是术前咨询和对镇痛方案的依从性（100％）。总发病率为26.5%，但是仅在3例患者中观察到严重的发病率(Dindo-Clavien>3)(6%)。严重发病率与ERP无关。
结论：强化康复方案在粘连性小肠梗阻手术患者中是可行和安全的，可促进胃肠功能的恢复。
背景：NCT04929275。这项研究对该领域有什么帮助？：需要改进粘连性小肠梗阻（ASBO）手术的围手术期管理，以降低发病率。在ASBO紧急手术后，增强恢复计划（ERP）既可行又安全。ERPs可以改善胃肠道（GI）功能的恢复。
