[Effect of initiation time of oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women]

Abdominal operations as gynaecological procedures result in gastrointestinal dysmotility. Early feeding and ambulation are nonpharmacologic interventions which can be useful in re-initiation of bowel function. This study was done to evaluate the effect of early oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women. In this randomized clinical trial, 120 primiparous women undergone elective cesarean section were assigned to control and intervention groups in Hajar hospital, Shahrekord, Iran during 2007. In the interventional group, oral hydration with liquids was started 4 hours after surgery regardless of presence of bowel sounds and solid food was started after bowel sounds appeared. The control group recieved liquid diet 12 hours after the operation if it was tolerated, they were given soft diet and regular food at the next meal. The return of bowel activity, time of ambulating, satisfaction, discharge from the hospital and complications were compared in two groups. The data were analyzed using SPSS-15, Chi-Square, T and one way ANOVA tests. The mean postoperative time interval to first hearing of normal intestinal sounds in interventional versus control groups were [9.5 +/- 1.38 and 12.5 +/- 2.5 hours] the first passage of flatus [15.7 +/- 3.61 vs.22.4 +/- 4.1 hours], time to first sensation of bowel movement [10.8 +/- 1.99 versus 15.7 +/- 3.4 hours] and defecation [18.9 +/- 3.65 versus 23.4 +/- 4.85 hours]. These differences were significant [P<0.05]. Also discharge from the hospital [0.96 +/- 0.18 versus 1.1 +/- 34 days] were significantly shorter in interventional group [P<0.05]. The women in the early feeding group got out of bed [patient mobilisation] earlier than their interventional group [14.1 hours versus 18.8 hours [P<0.05]. Maternal satisfaction was significantly higher among the early fed women [P<0.05]. Early oral hydration after elective cesarean section associated with rapid resumption of intestinal motility and increased woman's satisfaction

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

PURPOSE: Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09 percent) from the intervention and 3 patients (14.3 percent) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

Effect of gum chewing on prevention of post cesarean ileus

Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus. In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fishers exact probability test. The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds [14.7 hours vs. 16.6 hours; P=0.569], time intervals between surgery and abdominal distention [16.59 hours vs. 14.21 hours; P=0.01], first post operative defecation [28.16 hours vs. 32.21 hours; P<0.000], post operative time interval to onset diet [19.3 hours vs. 16.54 hours; P=0.000], post operative time interval to ambulation [20.14 hours vs. 17.58 hours; P=0.000], post operative lengths of ileus [31.13 hours vs. 30.35 hours; P=0.5], hospitalization [1.84 days vs. 1.92 days; P=0.02]. Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus

A comparative study of early postoperative feeding versus conventional feeding for patients undergoing cesarean section; a randomized controlled trial.

OBJECTIVE: To compare the efficacy and side effects of early postoperative feeding versus conventional feeding for patients undergoing cesarean section. MATERIAL AND METHOD: Women undertaking uncomplicated cesarean section under regional anesthesia were randomly assigned to early feeding or conventional feeding groups. Early-fed women were offered a liquid diet within 8 hours after surgery, advanced to a soft diet on the next meal and then a regular diet. Conventional-fed women were prohibited from mouth-fed for the first 24 hours after surgery, advanced to a liquid diet on the first postoperative day, and then a soft diet on the second postoperative day. RESULTS: Two hundred patients were enrolled in the study; 107 patients were assigned to the early feeding group and 93 patients to the conventional feeding group. There were no significant differences in the demographic data between the two groups. In all cases, consistent anesthetic method was applied with no intraoperative adhesion and no post operative complications were observed. The rate of mild ileus symptoms in the early feeding group was significantly less than the conventional group (19.6% versus 31.1%, p = 0.03). The early feeding group also had significantly shorter time interval to bowel movement (16.7 hours versus 25.3 hours, p < 0.001), duration of intravenous fluid administration (20.5 hours versus 24.8 hours, p < 0.001), and overall length of hospital stays (3.3 days versus 4.0 days, p < 0.001). CONCLUSION: The study results indicated that the early feeding after uncomplicated cesarean section had reduced the rate of ileus symptoms and offer potential benefits associated with shorter interval to bowel movement, intravenous fluid administration, and length of hospital stays. However, management of postoperative feeding requires proper counseling on details of both regimens and flexibilities should be provided to accommodate early feeding when requested by the patients.

Ileo biliar colónico: una causa poco frecuente de obstrucción intestinal, presentación de caso / Colonic gallstone ileus: a rare cause of intestinal obstruction, case report

Introducción: El íleo biliar es una complicación poco frecuente en la historia natural de la coledocolitiasis y representa una causa inusual de obstrucción intestinal.Objetivo: Presentación de caso y revisión bibliográfica.Lugar: Hospital Polivalente de Alta ComplejidadMaterial y Métodos: Presentación de caso. Revisión de literatura.Caso Clínico: Muejer 73 años, con diagnóstico de abdomen agudo oclusivo.Conclusión: El íleo biliar es una causa poco frecuente de oclusión intestinal. Es fundamental para el diagnóstico su sospecha.