COMPARISON OF ILEAL CONDUIT AND TUUC: A 4 YEARS STUDY

Objective: This study aims to compare 4 years of experience of IC and TUUC in the same period and among similar experienced surgeons. Material & Methods: Between January 2016 and August 2019, 44 radical cystectomies were performed, but 4 patients were excluded due to incomplete data or who underwent neo-bladder procedures. The primary endpoint was 30 days of complication rate and intraoperative complications. Bowel movement, ambulation, and length of stay (LOS) postoperatively were followed-up over a period of 30-day postoperatively. Results: 12 male patients underwent TUUC and 24 male patients IC, while only 4 female patients underwent IC. The mean of LOS of IC was 12.72 8.6 and 10.08 3.5 for TUUC; there were no significant differences between arms. However, TUUC had lower intra-operatively bleeding (779.17 441.15 ml) compared to IC (1328.57 810.40 ml). There was no difference in early complications between arms. Conclusion: Our results suggest that TUU with UC diversion may be used as a viable option of urinary diversion in radical cystectomy. This technique provides similar safety both surgically and oncologically.

The effect of coffee/caffeine on postoperative ileus following elective colorectal surgery: a meta-analysis of randomized controlled trials

Purpose Postoperative ileus (POI) is the most common complication of elective colon resection. Coffee or caffeine has been reported to be useful in improving gastrointestinal function after abdominal surgery. This study aimed to investigate the effect of coffee/caffeine on POI in patients undergoing elective colorectal surgery. Methods We searched Cochrane library, Embase, PubMed, and ClinicalTrials.gov (until July 2021) to identify randomized controlled trials (RCTs) evaluating the effect of coffee or caffeine on bowel movements and POI in patients undergoing elective colorectal surgery. The mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were calculated and are presented with 95% confidence intervals (CIs). A random effects model was used in all meta-analyses. Results A total of four RCTs including 312 subjects met the inclusion criteria and were included in the meta-analysis. Postoperative coffee or caffeine consumption decreased the time to first bowel movement (MD, − 10.36 h; 95% CI, − 14.61 to − 6.11), shortened the length of hospital stay (MD, − 0.95 days; 95% CI, − 1.57 to − 0.34), and was associated with a decreased risk of the use of any laxatives after the procedure (RR, 0.64; 95% CI, 0.44 to 0.92). The time to first flatus, time to tolerance of solid food, risk of any postoperative complication, postoperative reinsertion of a nasogastric (NG) tube, and anastomotic leakage showed no statistical differences between groups. Conclusion Postoperative coffee or caffeine consumption improved bowel movement and decreased the duration of hospital stay in patients undergoing elective colorectal surgery. This method is safe and can prevent or treat POI.

Effects of Reversal Technique for Neuromuscular Paralysis on Time to Recovery of Bowel Function after Craniotomy

Background Non-depolarizing neuromuscular blockade can be reversed with neostigmine/glycopyrrolate or sugammadex. We test the hypothesis that sugammadex is associated with earlier postoperative recovery of bowel function (first bowel movement, BM). Methods In adult patients undergoing craniotomy from 2016 to 2019, we identified time of first postoperative BM after receiving neostigmine/glycopyrrolate or sugammadex to reverse neuromuscular blockade. Logistic and proportional hazard regression, with and without inverse probability of treatment weighting (IPTW), were used to assess whether sugammadex is associated with earlier recovery of bowel function. Results Seven hundred and thirty-one patients underwent craniotomy, 323 (44.2%) received neostigmine/glycopyrrolate, and 408 (55.8%) sugammadex. From logistic regression analysis, the proportion of patients having a BM within the first 24 and 48 hours was higher in sugammadex group (unadjusted OR [95% CI]) 1.79 [1.16 to 2.77] P = .009; and 1.45 [1.08 to 1.94] P = .014; IPTW adjusted OR [95% CI]) 1.58 [.95, 2.61] P = .078; and 1.38 [.95 to 2.02] P = .095 for 24 and 48 h, respectively). From proportional hazards regression, sugammadex was associated with improved bowel function recovery (unadjusted hazard ratio (HR) [95% CI] 1.35 [1.08, 1.68], P = .008; IPTW adjusted HR 1.29 [.97 to 1.71], P = .076). Conclusion Patients undergoing craniotomy who had neuromuscular blockade reversed with sugammadex may have earlier recovered bowel function compared to patients reversed with neostigmine/glycopyrrolate.

Management of Grahani roga in Ayurveda (irritable bowel syndrome)- A case report

Grahani Roga is a common Gastro-intestinal Tract disorder of present era. In Ayurveda, Grahani is considered as the main functional part of Mahasrota which is located in between amashaya & pakwashaya, also known as the 6th kala i.e., Pittadhara Kala where jatharagni resides and its main function is to hold the ahara upto the end of avasthapaka & after completion passes it into pakvasaya. Symptoms like alternate passing of hard & loose stool, abdominal pain, passing of foul-smelling stool, mucus in faecal matter are diagnostic of Grahani Roga. In modern science, above mentioned symptoms can be correlated with IBS (Irritable Bowel Syndrome). In IBS, the wall of the intestine becomes sensitive to even mild stimulus which causes excess abdominal cramps & hence the bowel movement alters along with indigestion. In this case an effort has been made to treat 33 years male suffering from Grahani roga, at Ayurveda Teaching Hospital within 3 months by various ayurveda medicine and panchakarma procedures.

EARLY VERSUS DELAYED ORAL INTAKE IN PATIENTS AFTER CESAREAN SECTION UNDER REGIONAL ANESTHESIA

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018. Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water) <5 hours after cesarean section and in group 2, patients received sips of water 8 hours following surgery. Bowel motility was assessed after surgery on hourly basis. Data about time interval to first bowel movement and ileus were noted. Results: Mean age of patients was 32.329 ± 3.44 years and 33.051 ± 3.64 years in group 1 and 2 respectively. Mean gestational age and body mass index was 38.50 ± 0.93 weeks and 29.824 ± 4.97 kg/m2 in group-1 versus 37.937 ± 0.98 weeks and 27.779 ± 2.81 kg/m2 in group 2. Mean duration of surgery was 47.096 ± 6.65 minutes in group-1 and 47.647 ± 8.76 minutes in group 2. Ileus was seen in 17% patients in group-1 and 34.1% in group-2 (p<0.001). Mean time interval for first bowel movement was 8.323 ± 1.20 hours in group-1 and 13.034 ± 2.54 hours in group 2 (p<0.001). Conclusion: Early feeding after an uncomplicated cesarean section has reduced rate of ileus symptoms and mean time interval for bowel......

Superiority of mosapride citrate to picosulfate sodium as a laxative for withdrawal from regular enemas in children with severe functional constipation

Background: Severe functional constipation (FC) with low bowel movement frequency (BMF) of ?1 day/week and hard stools oftenrequires regularly repeated enemas or often leads to enema dependency (ED). Aim: The current study aimed to compare the efficacy of mosapride citrate (Mo) with the traditional stimulant laxative picosulfate sodium (Pi) for withdrawal from ED in children with severe FC. Results: Twenty-four treatment-naïve patients who met the Rome IV diagnostic criteria for FC seen at our center for 8 years from 2012 were enrolled. Glycerin enema was repeated until the BMF was ?3.5 days/week. Simultaneously, Mo at 0.3 mg/kg/day (n=11) or Pi at 0.25 mg/kg/day (n=13) was administered concomitantly with magnesium oxide or lactulose. The proportion of withdrawal from ED was significantly higher in the Mo group than Pi group during the 4 months observational period (90.9% vs. 46.2%, respectively; p=0.034) and shorter in time to withdraw from ED (0 vs. 3.5 months, respectively; p=0.015). Conclusion: Mo is more effective than Pi for withdrawal from ED in children with severe FC.

STRESS AND CONSTIPATION (VIBANDHA) - CRITICAL REVIEW

Thoughts and emotions triggered by stress can have an effect on stomach and bowel movement. Physical signs and symptoms of stress overload include chest pain, rapid heartbeat, loss of sexual drive, diarrhoea/ constipation. In this article we have tried to enlighten the association of stress and constipation. The mainly observed clinical features of Vibandha are Hard Stools, Excessive Straining, Sense of Incomplete Evacuation, Flatulence and Lower Abdominal Fullness. The stress hormone may contribute to constipation.

Ultrasonographic Evaluation of Bowel Wall Thickness and Intramural Blood Flow in Ulcerative Colitis

Background Ulcerative colitis, a type of inflammatory bowel disease that merely affects the mucosa and submucosa of colon in the form of inflammatory ulcers. Colonoscopy is the gold standard for its diagnosis. For optimal monitoring of disease activity in UC patients, colonoscopy should be performed on a regular basis. However, repeated colonoscopies represent a logistic and economic challenge, as well as significant burden for the patients. Objectives Our study aimed to provide an extensive overview of the main pathologic features of gut wall vessels and bowel wall thickness at US examination of UC. Patients and Methods This prospective case control study was done on 40 patients confirmed to have UC attending to Outpatient Clinics of Internal Medicine and Gastroenterology Department – Ain-Shams University from October 2018 to Augost 2019. They were divided into two groups: Relapse group: Include 20 patients with active UC disease. Remission group: Include 20 patients with inactive UC disease (in remission state). These two groups were matched with 20 healthy individuals, matched for age and gender and considered to be a control group. Disease activity was categorized according to the endoscopic Mayo score.Ultrasound and endoscopic findings were compared for each colon segment except for the rectum. Results The peak incidence of affected patients was 30–40 years of age. Female predominance compared to male with a ratio of 2.6:1. 20% of remission patients complaining from 1-2 bowel movement while 45% and 50% of relapsing patients suffer from 3-4 and 5 bowel movement respectively. 100%, 100%, 20% and 15% of relapsing patients suffer from bleeding per rectum, abdominal pain, tenesmus and urgency. Higher ESR and CRP and lower hemoglobin in relapsing compared to remission group. Furthermore, The last group has higher value of ESR and CRP and lower value of hemoglobin compared to control group. BWT was significantly thicker in relapse group (4.8±0.7 mm) than of remission (3.55±0.5 mm) compared to control group (1.6±0.5) (p value &lt;0.001). BWT at a cut-offs &gt; 4 mm discriminating between cases with relapse from those with remission and at a cut-offs &gt;4 mm discriminating between mild endoscopic severity from moderate and severe UC. Furthermore, BWT at a cut-offs &gt;4.6 mm discriminating between mild and moderate endoscopic severity from severe UC. Vascular signal number at a cut-offs &gt;1 discriminating between cases with relapse from those with remission and at a cut-offs &gt;2 discriminating between mild and moderate endoscopic severity of UC. Conclusion Abdominal ultrasound is a widely available non-invasive method for imaging of UC. It provides a high sensitivity, specificity and accuracy in diagnosis and monitoring of UC activity.