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Andreas Hecker - One of the best experts on this subject based on the ideXlab platform.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection
International Journal of Colorectal Disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:PurposePostoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial.MethodsWe present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model.ResultsOf 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection ( p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03].ConclusionsAlthough the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection.
International journal of colorectal disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:Postoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial. We present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model. Of 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection (p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03]. Although the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
Giovanni Quarta - One of the best experts on this subject based on the ideXlab platform.
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Paralytic Ileus following “subcutaneous bortezomib” therapy: focus on the clinical emergency—report of two cases
Clinical and Experimental Medicine, 2016Co-Authors: Giuseppe Mele, Maria Rosaria Coppi, Angela Melpignano, Giovanni QuartaAbstract:We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the “novel subcutaneous formulation of bortezomib.” In our experience, two patients (10 %) discontinued treatment for Paralytic Ileus. The exact pathogenetic mechanisms of toxic megacolon and Paralytic Ileus due to “novel subcutaneous formulation of bortezomib” are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension.
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Paralytic Ileus following "subcutaneous bortezomib" therapy: focus on the clinical emergency-report of two cases.
Clinical and experimental medicine, 2015Co-Authors: Giuseppe Mele, Maria Rosaria Coppi, Angela Melpignano, Giovanni QuartaAbstract:We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the “novel subcutaneous formulation of bortezomib.” In our experience, two patients (10 %) discontinued treatment for Paralytic Ileus. The exact pathogenetic mechanisms of toxic megacolon and Paralytic Ileus due to “novel subcutaneous formulation of bortezomib” are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension.
Martin Reichert - One of the best experts on this subject based on the ideXlab platform.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection
International Journal of Colorectal Disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:PurposePostoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial.MethodsWe present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model.ResultsOf 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection ( p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03].ConclusionsAlthough the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection.
International journal of colorectal disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:Postoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial. We present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model. Of 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection (p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03]. Although the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
Giuseppe Mele - One of the best experts on this subject based on the ideXlab platform.
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Paralytic Ileus following “subcutaneous bortezomib” therapy: focus on the clinical emergency—report of two cases
Clinical and Experimental Medicine, 2016Co-Authors: Giuseppe Mele, Maria Rosaria Coppi, Angela Melpignano, Giovanni QuartaAbstract:We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the “novel subcutaneous formulation of bortezomib.” In our experience, two patients (10 %) discontinued treatment for Paralytic Ileus. The exact pathogenetic mechanisms of toxic megacolon and Paralytic Ileus due to “novel subcutaneous formulation of bortezomib” are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension.
-
Paralytic Ileus following "subcutaneous bortezomib" therapy: focus on the clinical emergency-report of two cases.
Clinical and experimental medicine, 2015Co-Authors: Giuseppe Mele, Maria Rosaria Coppi, Angela Melpignano, Giovanni QuartaAbstract:We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the “novel subcutaneous formulation of bortezomib.” In our experience, two patients (10 %) discontinued treatment for Paralytic Ileus. The exact pathogenetic mechanisms of toxic megacolon and Paralytic Ileus due to “novel subcutaneous formulation of bortezomib” are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension.
Jörn Pons-kühnemann - One of the best experts on this subject based on the ideXlab platform.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection
International Journal of Colorectal Disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:PurposePostoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial.MethodsWe present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model.ResultsOf 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection ( p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03].ConclusionsAlthough the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
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Protective loop ileostomy increases the risk for prolonged postoperative Paralytic Ileus after open oncologic rectal resection.
International journal of colorectal disease, 2018Co-Authors: Martin Reichert, Jörn Pons-kühnemann, Winfried Padberg, Matthias Hecker, Christian Weber, Andreas HeckerAbstract:Postoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged Ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative Paralytic Ileus remains multifactorial. We present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative Paralytic Ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative Paralytic Ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model. Of 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative Paralytic Ileus after oncologic rectal resection (p = 0.047). Odds ratio for prolonged postoperative Paralytic Ileus in patients with ileostomy was 4.96 [95% CI 1.02–24.03]. Although the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
