Our Summary

After having colon surgery, some patients experience a condition known as prolonged postoperative ileus (PPOI). This is when the intestines are slow to return to normal function, causing issues like constipation and bloating. This can lead to a longer hospital stay, more complications, and higher cost for patients and hospitals.

Recently, some researchers have suggested that the recovery of the gut function after surgery may depend on which side of the colon was operated on - the right side or the left side.

To explore this idea, a systematic review and meta-analysis (a statistical technique that combines the findings from independent studies) were conducted. They looked at studies that reported on the recovery of the gut function in adults who had elective surgery on the right or left side of the colon.

The main outcome they were interested in was PPOI, and they also looked at the time to first passage of gas and stool, the time until patients could tolerate a solid diet, and any complications after surgery.

They identified nine studies, seven of which were included in their analysis. These studies included 29,068 colon surgeries (14,581 on the right side and 14,487 on the left side). They found that PPOI was more likely to occur after right-sided colon surgery compared to left-sided surgery, regardless of the surgical approach.

However, the secondary outcomes were only reported in a few small studies, so they couldn’t draw reliable conclusions about those.

In summary, for reasons currently unknown, patients having right-sided colon surgery are more likely to experience PPOI than those having left-sided surgery. More research is needed to understand why this is the case.

FAQs

  1. What is prolonged postoperative ileus (PPOI) and how does it relate to colonic surgery?
  2. Does the side of resection (right-sided vs. left-sided colectomy) affect gastrointestinal recovery?
  3. What further research is needed to understand the higher rates of PPOI following right- versus left-sided colectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colectomy is to be aware that gastrointestinal recovery may vary depending on the side of resection (right-sided vs. left-sided). Patients undergoing right-sided colectomy may be at a higher risk for prolonged postoperative ileus, so it is important to follow postoperative care instructions closely and communicate any concerns with your healthcare provider.

Suitable For

Patients who are recommended colectomy typically have conditions such as colon cancer, inflammatory bowel disease, diverticulitis, or other conditions that affect the colon. The decision to recommend colectomy is made based on the specific condition and the individual patient’s health status. Factors such as the extent of the disease, the presence of complications, and the patient’s overall health and ability to tolerate surgery are taken into consideration when determining if colectomy is the best treatment option.

Timeline

Before colectomy:

  1. Patient is diagnosed with a condition requiring colectomy, such as colorectal cancer, inflammatory bowel disease, or diverticulitis.
  2. Patient undergoes preoperative evaluations and tests to assess overall health and suitability for surgery.
  3. Patient may need to follow a special diet or take medications to prepare for surgery.
  4. Patient meets with the surgical team to discuss the procedure, potential risks, and postoperative care.

After colectomy:

  1. Patient undergoes surgery to remove a portion of the colon (right-sided or left-sided colectomy).
  2. Patient is closely monitored in the immediate postoperative period for complications such as infection, bleeding, or bowel obstruction.
  3. Patient may experience pain, discomfort, and fatigue following surgery.
  4. Patient is gradually allowed to resume eating and drinking, starting with clear liquids and progressing to solid foods.
  5. Patient may need to take medications to manage pain, prevent infection, and promote healing.
  6. Patient is encouraged to move around and engage in light physical activity to aid in recovery.
  7. Patient may experience postoperative ileus, a common complication characterized by delayed gastrointestinal recovery.
  8. Patient is discharged from the hospital once stable and able to manage self-care at home.
  9. Patient follows up with their surgical team for monitoring and management of any ongoing issues or complications.
  10. Patient undergoes follow-up tests and examinations to ensure the success of the surgery and overall health.

What to Ask Your Doctor

  1. What is the likelihood of experiencing prolonged postoperative ileus (PPOI) following a colectomy on the right side versus the left side?
  2. How does the recovery time differ between a right-sided and left-sided colectomy, in terms of time to first passage of flatus, stool, and tolerance of solid diet?
  3. Are there any specific risk factors or patient characteristics that may influence the likelihood of PPOI following a colectomy?
  4. What steps can be taken to minimize the risk of PPOI and promote faster gastrointestinal recovery following a colectomy?
  5. Are there any differences in postoperative complications between right-sided and left-sided colectomies that I should be aware of?
  6. Will I need any specific postoperative care or follow-up appointments based on the side of the colectomy performed?
  7. Are there any additional tests or screenings that should be considered prior to or following the colectomy to monitor gastrointestinal recovery?
  8. What is the expected length of hospital stay and recovery time following a colectomy on the right side versus the left side?
  9. Are there any restrictions or modifications to my diet or activity level that I should follow after the colectomy, based on the resection side?
  10. Are there any ongoing research or clinical trials investigating the differences in gastrointestinal recovery between right-sided and left-sided colectomies that I may be eligible to participate in?

Reference

Authors: Seo SHB, Carson DA, Bhat S, Varghese C, Wells CI, Bissett IP, O’Grady G. Journal: Colorectal Dis. 2021 Dec;23(12):3113-3122. doi: 10.1111/codi.15969. Epub 2021 Nov 16. PMID: 34714601