Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative

Background: Postoperative ileus usually lasts for 2-5 days after colonic surgery and may contribute to discomfort and pulmonary complications. With multimodal rehabilitation (epidural analgesia, early oral nutrition and mobilization, and laxative) defaecation occurs 1-2 days after colonic surgery. The aim of this study was to assess the transit rate of the entire gastrointestinal tract after colonic resection with multimodal rehabilitation. Methods: Gastrointestinal motility was assessed by means of a scintigraphic method in 12 patients undergoing open colonic resection with multimodal rehabilitation and in 12 matched healthy volunteers. After intragastric or oral administration of 4 MBq In-111-labelled diethylenetriamine pentaacetic acid, images of the abdomen were taken at 24 and 48 h with a double-headed gamma camera. Results: Patient and volunteer demographics were similar. The first defaecation occurred a median of 1 day after operation in the patients. Some 57 per cent of the tracer was excreted in faeces of patients and 53 per cent in faeces of volunteers (P>0.05) within 48 It, indicating rapid recovery of the entire gastrointestinal motility after colonic resection with multimodal rehabilitation. Conclusion: This study documents early normalization of the entire gastrointestinal motility assessed by an In-111 scintigraphic method in patients undergoing open colonic resection with a multimodal rehabilitation programme.