Usefulness of Gum Chewing to Decrease Postoperative Ileus in Colorectal Surgery with Primary Anastomosis: A Randomized Controlled Trial.

BACKGROUND: Postoperative ileus generates a high impact on morbidity, hospital stay, and costs. OBJECTIVE: To study the efficiency and safety of chewing gum to decrease postoperative ileus in colorectal surgery. METHOD: A randomized controlled trial was performed including 64 patients who underwent elective colorectal surgery with primary anastomosis in a tertiary referral center. Patients were divided in two groups: (i) A: gum chewing group (n = 32), and (ii) B: patients who had standard postoperative recovery (n = 32). RESULTS: Postoperative ileus was observed in 6% (2/32) of the gum-chewing group and in 21.8% (7/32) in the standard postoperative recovery group, with an odds ratio of 0.167 (95% CI: 0.37-0.75; p = 0.006). Vomiting was present in two patients from group A and in eight from group B (6.25 vs. 25.0%; p = 0.03). Passage of flatus within the first 48 hours was present in 30 patients from group A and in 20 from group B (94 vs. 63%; p = 0.002). There was earlier oral feeding (96 ± 53 vs. 117 ± 65 hours; p= 0.164) and a shorter length of hospital stay (7 ± 5 vs. 9 ± 5 days; p= 0.26) in the gum-chewing group (p N.S.). CONCLUSIONS: The use of chewing gum after colorectal surgery was associated with less postoperative ileus and vomiting, and with an increased passage of flatus within the first 48 hours after surgery. Since gum chewing is an inexpensive procedure and is not associated with higher morbidity, it can be safely used for a faster postoperative recovery in elective colorectal surgery.

[Congenital diaphragmatic adult hernia. Case report]. / Hernia diafragmática congénita en el adulto. Informe de un caso.

BACKGROUND: Bochdalek's hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side. It appears frequently in infants and is rare in adults. Diagnosis is incidental or when it becomes symptomatic. Our objective was to offer the general surgeon a differential diagnosis for presence of noncardiac thoracic pain in the adult. CLINICAL CASE: We present the case of a 78-year-old female with cardiorespiratory and digestive symptoms of slight intensity and managed for many years as hypertensive cardiopathy and dyspeptic syndrome until she was admitted to our service with severe epigastric pain. Postero-anterior x-ray of the thorax demonstrated the presence of the stomach in the thoracic cavity. This was confirmed by barium esophagogram, upper gastrointestinal endoscopy and abdominal CT scan where porcelain gallbladder was also detected. The patient underwent abdominal surgery where a large diaphragmatic hernia was found with the complete stomach and small bowel inside. Primary repair of the diaphragm and cholecystectomy were performed, confirming gallbladder cancer. DISCUSSION: It is frequent that thoracic pain in patients of advanced age is interpreted as cardiac and/or digestive pathology and that more diagnostic investigation is not pursued due to patient age and invasive nature of the studies. Therefore, patients are treated according to their symptoms. It is important that the surgeon establishes an etiological diagnosis in order to offer appropriate treatment. CONCLUSIONS: Congenital diaphragmatic hernia in the adult is rarely suspected in the differential diagnosis of noncardiac thoracic pain. The surgeon must keep this in mind, especially in patients of advanced age, even when cardiac and/or gastrointestinal diagnosis is confirmed.

Hernia diafragmática congénita en el adulto: informe de un caso / Congenital diaphragmatic adult hernia: case report

BACKGROUND: Bochdalek's hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side. It appears frequently in infants and is rare in adults. Diagnosis is incidental or when it becomes symptomatic. Our objective was to offer the general surgeon a differential diagnosis for presence of noncardiac thoracic pain in the adult. CLINICAL CASE: We present the case of a 78-year-old female with cardiorespiratory and digestive symptoms of slight intensity and managed for many years as hypertensive cardiopathy and dyspeptic syndrome until she was admitted to our service with severe epigastric pain. Postero-anterior x-ray of the thorax demonstrated the presence of the stomach in the thoracic cavity. This was confirmed by barium esophagogram, upper gastrointestinal endoscopy and abdominal CT scan where porcelain gallbladder was also detected. The patient underwent abdominal surgery where a large diaphragmatic hernia was found with the complete stomach and small bowel inside. Primary repair of the diaphragm and cholecystectomy were performed, confirming gallbladder cancer. DISCUSSION: It is frequent that thoracic pain in patients of advanced age is interpreted as cardiac and/or digestive pathology and that more diagnostic investigation is not pursued due to patient age and invasive nature of the studies. Therefore, patients are treated according to their symptoms. It is important that the surgeon establishes an etiological diagnosis in order to offer appropriate treatment. CONCLUSIONS: Congenital diaphragmatic hernia in the adult is rarely suspected in the differential diagnosis of noncardiac thoracic pain. The surgeon must keep this in mind, especially in patients of advanced age, even when cardiac and/or gastrointestinal diagnosis is confirmed.