Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

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Arabic translation, cultural adaptation, and validation of Australian Pelvic Floor Questionnaire in a Saudi population

BMC Women s Health ◽

10.1186/s12905-020-01144-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haifaa Malaekah ◽

Haifaa Saud Al Medbel ◽

Sameerah Al Mowallad ◽

Zahra Al Asiri ◽

Alhanouf Albadrani ◽

...

Keyword(s):

Pelvic Floor ◽

Cultural Adaptation ◽

Pelvic Floor Dysfunction ◽

Bowel Function ◽

Internal Consistency Reliability ◽

Bladder Function ◽

Arabic Version ◽

Saudi Population ◽

Prolapse Symptoms ◽

Pelvic Floor Questionnaire

Abstract Introduction and hypothesis The aims of the study were the translation, cultural adaptation, and validation of self-administered Australian Pelvic Floor Questionnaire (APFQ) on a Saudi population. Methods The translation and cultural adaptation was performed in 854 women over 18 and not pregnant who agreed to answer the Arabic version of the questionnaire. The content/face validity, internal consistency (reliability), and construct validity (factor analysis) were assessed. Statistical analysis was carried out using SPSS 24.0 statistical software. Results The Cronbach’s alpha results were above 0.8 for the questionnaire’s overall reliability (bladder function: 0.877, bowel function: 0.834, prolapse symptoms: 0.784, sexual function: 0.762) showing adequate internal consistency reliability and high statistical significance. A statistically significant correlation was observed among the 40 items of the questionnaire. The issue of multicollinearity was not found, and the determinant of the correlation matrix was 0.001. A value of > 0.5 was achieved when the Kaiser–Meyer–Olkin and Bartlett’s tests measured 0.806 and the Bartlett’s test of sphericity was statistically significant χ2 (780) = 4150.46 (p < 0.001). The values of loading indicate that all 4 factors (bladder function, bowel function, prolapse symptoms, sexual function) contributed to each of their items. Conclusions This study provides the Arabic version of the self-administered APFQ as a reliable and valid instrument for evaluating symptom severity and impact of pelvic floor dysfunction on the quality of life of Arabic women. It also will enable the researchers from Arab countries to use this instrument to assess pelvic floor dysfunction prevalence in their settings.

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Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Nutrients ◽

10.3390/nu13020626 ◽

2021 ◽

Vol 13 (2) ◽

pp. 626

Author(s):

Ángela Rodríguez-Padilla ◽

Germán Morales-Martín ◽

Rocío Pérez-Quintero ◽

Juan Gómez-Salgado ◽

Rafael Balongo-García ◽

...

Keyword(s):

Colorectal Carcinoma ◽

Postoperative Ileus ◽

Loop Ileostomy ◽

Bowel Function ◽

Ileostomy Closure ◽

Controlled Study ◽

Control Group ◽

Double Blind ◽

Colorectal Cancer Surgery ◽

Stimulation Of

Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.

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Quality of Life following Chemoradiotherapy for Localized Muscle Invasive Bladder Carcinoma: A Systematic Review

Bladder Cancer ◽

10.3233/blc-210011 ◽

2021 ◽

pp. 1-13

Author(s):

Ben-Max De Ruiter ◽

Abel N. Keijzer ◽

Maarten C.C.M. Hulshof ◽

Adriaan D. Bins ◽

Theo M. de Reijke ◽

...

Keyword(s):

Quality Of Life ◽

Sexual Function ◽

Bladder Carcinoma ◽

Bowel Function ◽

Definitive Treatment ◽

Cochrane Library ◽

Social And Emotional ◽

Muscle Invasive ◽

The Impact

BACKGROUND: Health related Quality of Life (HRQoL) is an important factor regarding treatment for localized Muscle Invasive Bladder Carcinoma (MIBC), as it may affect choice of treatment. The impact of chemoradiotherapy (CRT) for MIBC on HRQoL has not yet been well-established. OBJECTIVE: To systematically evaluate evidence regarding HRQoL as assessed by validated questionnaires after definitive treatment with CRT for localized MIBC. METHODS: We performed a critical review of PubMed/MEDLINE, EMBASE, and the Cochrane Library in October 2020. Two reviewers independently screened articles for eligibility and assessed the methodological quality of the included articles using Joanna Briggs Institute critical appraisal tools. A narrative synthesis was undertaken. RESULTS: Of 579 articles identified, 11 studies were eligible for inclusion, including three RCTs and 8 non-randomized studies, reporting on HRQoL data for 606 CRT patients. Global health declined at End of treatment (EoT), and recovered 3 months following treatment. Physical function declined from baseline at EoT and recovered between 3 and 24 months and was maintained at 5 years follow up. CRT had little effect on social and emotional function in the short-term, but HRQoL results in the long-term were lower compared to the general population. Urinary function declined from baseline at EoT, but returned to baseline at 6 months following CRT. After initial decline in bowel function, a complete return to baseline occurred 4 years following treatment. The majority of studies assessing sexual function showed no to little effect on sexual function. CONCLUSIONS: HRQoL recovers to baseline within 3 months to 2 years in almost all domains. The amount of available evidence regarding HRQoL following CRT for MIBC is limited and the quality of evidence is low.

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Evaluation of Bowel Function Following Radical Cystectomy and Urinary Diversion Using Two Validated Questionnaires: What Are the Effects on Quality of Life?

Urology ◽

10.1016/j.urology.2021.04.044 ◽

2021 ◽

Author(s):

Kian Asanad ◽

Azadeh Nazemi ◽

Saum Ghodoussipour ◽

Sanam Ladi-Seyedian ◽

Nima Nassiri ◽

...

Keyword(s):

Quality Of Life ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Bowel Function ◽

Validated Questionnaires

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The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10050964 ◽

2021 ◽

Vol 10 (5) ◽

pp. 964

Author(s):

Peter H. Gorman ◽

Gail F. Forrest ◽

Pierre K. Asselin ◽

William Scott ◽

Stephen Kornfeld ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Bowel Function ◽

Bowel Dysfunction ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Cord Injury ◽

Patient Reported ◽

Stool Form ◽

Time Since Injury

Bowel function after spinal cord injury (SCI) is compromised because of a lack of voluntary control and reduction in bowel motility, often leading to incontinence and constipation not easily managed. Physical activity and upright posture may play a role in dealing with these issues. We performed a three-center, randomized, controlled, crossover clinical trial of exoskeletal-assisted walking (EAW) compared to usual activity (UA) in people with chronic SCI. As a secondary outcome measure, the effect of this intervention on bowel function was assessed using a 10-question bowel function survey, the Bristol Stool Form Scale (BSS) and the Spinal Cord Injury Quality of Life (SCI-QOL) Bowel Management Difficulties instrument. Fifty participants completed the study, with bowel data available for 49. The amount of time needed for the bowel program on average was reduced in 24% of the participants after EAW. A trend toward normalization of stool form was noted. There were no significant effects on patient-reported outcomes for bowel function for the SCI-QOL components, although the time since injury may have played a role. Subset analysis suggested that EAW produces a greater positive effect in men than women and may be more effective in motor-complete individuals with respect to stool consistency. EAW, along with other physical interventions previously investigated, may be able to play a previously underappreciated role in assisting with SCI-related bowel dysfunction.

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