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Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery
Author(s) -
DudiVenkata Nagendra N.,
Kroon Hidde M.,
Bedrikovetski Sergei,
Moore James W.,
Sammour Tarik
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15319
Subject(s) - medicine , psychological intervention , randomized controlled trial , medline , cochrane library , colorectal surgery , systematic review , bisacodyl , gastrointestinal function , lactulose , protocol (science) , surgery , colorectal cancer , alternative medicine , abdominal surgery , colonoscopy , pathology , cancer , psychiatry , political science , law
Background Post‐operative ileus (POI) and delayed return of gastrointestinal (GI) function are common complications after colorectal surgery. There is a lack of uniformity in enhanced recovery protocols (ERPs) with regards to interventions used to target these complications. This systematic review aims to categorize and summarize management recommendations available from published ERPs. Methods A systematic search of Ovid MEDLINE, Embase, Cochrane Library and PubMed databases was performed from January 1990 to May 2018. All studies publishing enhanced recovery or fast‐track or multimodal pathway protocols for colorectal surgery in their full‐text were included. Data on interventions aimed at reducing the duration of POI were extracted, as well as references quoted to support specific interventions. Results Of 481 manuscripts screened, 37 published ERPs were identified from 37 studies (18 cohort, seven historical‐control, five guidelines, four randomized controlled trials, one randomized controlled trial protocol, one case series and one narrative review). The most commonly recommended interventions were magnesium‐based laxatives (18 of 37, 48.6%), chewing gum (13 of 37, 35.1%), Alvimopan (6 of 37, 16.2%), lactulose (4 of 37, 10.8%), neostigmine (2 of 37, 5.4%) and bisacodyl (2 of 37, 5.4%). Geographical trends were noted for the various interventions, but high‐quality evidence was only referenced to support the use of Alvimopan. Conclusion ERP recommendations specific to interventions targeting POI and return of GI function are varied. While laxatives are the most commonly recommended intervention, there is only weak evidence reported to support this practice.