Abstract:
Postoperative ileus results in significant morbidity, prolonged hospitalization, and increased healthcare expenditure. However, the underlying abnormalities in motility remain poorly understood. Recent high-resolution manometry studies demonstrated the distal colon becomes hyperactive with a cyclic motor pattern postoperatively, but did not track this activity beyond 16 hours after surgery. To use high-resolution manometry to evaluate distal colonic motility over the first four days after right-sided colectomy. This was an observational study of patients undergoing perioperative high-resolution colonic manometry using a 36-sensor catheter with 1-cm resolution. A single tertiary hospital. Adult patients undergoing elective laparoscopic or open right-sided colonic resection. Occurrence of distal colonic motor patterns over the perioperative period, defined according to a published classification system. Clinical markers of gut recovery included time to first stool, oral diet, and prolonged postoperative ileus. Seven patients underwent perioperative manometry recordings. Hyperactive cyclic motor patterns emerged intraoperatively and peaked in the first 12 hours postoperatively, occupying 81.8 ± 3.9% of the recording. This gradually returned to normal over the first 4 days, reaching 19.0 ± 4.4% (p = 0.002). No patient had a bowel motion prior to this hyperactivity resolving. High-amplitude propagating sequences were absent in early postoperative recordings, and their return temporally correlated with passage of stool. Abnormal high-amplitude repetitive 0.5-1 cycle/minute activity was observed in the left colon of one patient with prolonged ileus. The invasive nature of recordings limited this study to a small sample size. Cyclic motor patterns are markedly hyperactive in the distal colon following right-sided colectomy, and gradually resolve over the first four postoperative days. High-amplitude propagating sequences are inhibited by surgery and gradually recover. Bowel function may not return until these changes resolve. Other abnormal repetitive hyperactive patterns could contribute to the development of prolonged ileus. See Video Abstract at http://links.lww.com/DCR/B967.