Minerva Surgery最新文献

Background: Point-of-care ultrasound (POCUS) is increasingly utilized in clinical medicine, yet its role in assessing normal postoperative bowel function remains underexplored, particularly after laparoscopic colorectal surgeries.

Methods: A prospective cohort study of 20 laparoscopic bowel resection patients was conducted, utilizing small bowel POCUS before surgery and daily from postoperative day (POD) 1 to POD 4. Small bowel width and a Small Bowel Motility Index (SBMI) were recorded in each examination. Statistical analyses involved repeated measures ANOVA to evaluate motility and width changes over study days.

Results: The small bowel motility index displayed statistically significant differences across the study days before surgery up to POD4 (P<0.001). Pairwise comparisons revealed significant differences between pre-surgery (10.58±1.31) and POD1 (8.20±2.30) with a mean difference of 2.38 (P=0.009). Subsequent days demonstrated significant differences between POD1 and POD3 (9.78±1.51) and POD4 (10.30±2.05) with mean differences of -1.58 (P=0.049) and -2.10 (P=0.029) respectively. In contrast, small bowel width did not exhibit statistical significance during this follow-up period (P=0.112).

Conclusions: Our findings underscore the dynamic nature of small bowel motility, highlighting its potential as a crucial parameter for postoperative assessment. Further larger studies with vareity of patients are warranted to explore the broader applications of small bowel POCUS in postoperative care.

Introduction: Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating. Pain after hemorrhoidectomy is also common and distressing. These conditions are at least initially managed conservatively. An ointment formulation containing the calcium channel blocker nifedipine and the local anesthetic lidocaine has an established role in the treatment of rectal conditions, particularly conditions associated with anal sphincter hypertonia such as hemorrhoidal disease and anal fissure. This review aimed to compile the evidence for the use of nifedipine 0.3% and lidocaine 1.5% ointment in treating these common but bothersome anorectal diseases.

Evidence acquisition: A comprehensive literature search was conducted, updated to 07 August 2024, using PubMed and MEDLINE databases to identify studies of lidocaine and nifedipine, alone or in combination, for the topical treatment of anal fissure or hemorrhoidal disease. Articles identified in the literature search were supplemented by ad hoc searches and supplemented by relevant literature known to the authors.

Evidence synthesis: Nifedipine 0.3% and lidocaine 1.5% ointment is effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy. The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%.

Conclusions: Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited, nifedipine 0.3% and lidocaine 1.5% ointment should be considered a valid treatment option for clinicians treating anorectal diseases. Further studies are warranted to confirm and extend the results reported.