The Effect of Hot Pack Application on Postoperative Ileus Undergoing Surgery for Gynecologic Malignancies

Erzincan Military Hospital130 enrolled

Overview

Postoperative ileus (POI), is an extensively known complication characterized by an impairment of normal gastrointestinal motor activity after abdominal surgery and may also occur after surgery at other sites due to non-mechanical causes. \[1\]. This clinical asset has been linked to prominent perioperative morbidity with the following financial burden owing to extended hospitalization \[1\]. Furthermore, POI can postpone adjuvant treatments, such as chemotherapy in patients who went through surgery for cancers. Abdominal tenderness and distension, nausea and vomiting, delay in the passage of flatus and stool, and intolerance to solid food are the prime symptoms of POI \[1-3\]. It is generally transient, but if prolonged, can cause surgical incision dehiscence, intestinal anastomotic fistula, abdominal cavity infection, intestinal ischemia, aspiration pneumonia, and other serious complications \[4-6\]. Hence, many clinicians have focused on averting POI. Many studies have analyzed preventive methods, such as preoperative mobilization of the patient, adequate pain control, gum chewing, epidural anesthesia, coffee consumption, and motility agents such as metoclopramide and alvimopan \[7-15\]. For all the manifold remedy approaches, POI maintains a difficult clinical challenge that compromises the rapid improvement of patients who underwent abdominal surgery. Recently, thermal attempts have been employs for several situations such as inflammatory bowel disease, chronic pelvic pain, and abdominal pain \[16\]. It may be used in two different ways; whole body or local. Local thermal therapy can be carried out by hot pack or paraffin \[17\]. It has been demonstrated that local thermotherapy abate myotonia, enhances circulation, and eases pain by expediting the removal of the pain-producing substance. Local thermal therapy is widely used for a number of conditions such as pain, nausea, vomiting, and some bowel diseases in traditional Chinese medicine \[18\].

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * patiens aith aged ≥18 years olds * patients undergoing elective exhaustive staging surgery (total hysterectomy (Type A-C2), systematic pelvic para-aortic lymphadenectomy ± bilateral salpingo-oophorectomy and ± omentectomy by abdominal approach containing either open or laparoscopic surgery. Exclusion Criteria: * ASA score \>3, * chronic constipation (defined as ≤2 bowel movements per week), * inflammatory bowel disease, * irritable bowel syndrome, * compromised liver function, * clinically significant cardiac arrhythmia, * Thyroid disorder, * History of abdominal bowel surgery, * previous abdominal irradiation, * previous neoadjuvant chemotherapy or hyperthermic intraperitoneal chemotherapy, * Performed upper abdominal surgery * The covid-19 positive test result, * bowel anastomosis.

Outcomes

Primary Outcomes

time to the first passage of flatus after surgery

Patients were checked hourly for bowel sounds by auscultation and were asked to note the time of first flatus and defecation and to inform the clinical nurses or an assistant.

Time frame: up to 72 hours

Secondary Outcomes

The time to tolerate a solid diet

The time to tolerate a solid diet was measured from the end of operation, referred to the time when the patient awoke from anesthesia, until the patient tolerated intake of solid food (any food that required chewing) without vomiting

Time frame: Up to 5 days

The time to the first bowel movement

The time to the first bowel movement was referred to the time to the first audible bowel sound during routine postoperative care. Patients were checked hourly for bowel sounds by auscultation and were asked to note the time of first flatus and defecation and to inform the clinical nurses or an assistant.