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Updates in Surgery
Published in: Updates in Surgery 6/2021

01-12-2021 | Rectal Cancer | Original Article

High-pressure CO2 insufflation is a risk factor for postoperative ileus in patients undergoing TaTME

Authors: Michele Grieco, Flavio Tirelli, Annamaria Agnes, Pietro Santocchi, Alberto Biondi, Roberto Persiani

Published in: Updates in Surgery | Issue 6/2021

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Abstract

The aim of this study is to evaluate the influence of high-pressure CO2 insufflation during TaTME on the occurrence of postoperative ileus. All patients undergoing elective transanal total mesorectal excision (TaTME) between April 2015 and March 2019 were included in a prospective database. Eligible patients were adults with mid and low-level rectal cancer undergoing elective TaTME with colorectal anastomosis and diverting ileostomy, following a standardized ERAS pathway. Patients were divided into a low-pressure (LP) group, where surgery was performed with an intrabdominal CO2 pressure of 12 mmHg, and a high-pressure (HP) group, where the intrabdominal pressure reached 15 mmHg of CO2 once the two surgical fields were connected. Of 98 patients undergoing TaTME in the observed period, 74 met the inclusion criteria and were included in this study. There was no significant difference in postoperative complications between the LP and HP groups, except for postoperative ileus, which occurred in seven patients (13.2%) in the LP group and seven patients (33.3%) in the HP group (p value 0.046). The logistic multivariate analysis showed that a high intraabdominal CO2 pressure (OR 7040, 95% CI 1591–31,164, p value 0.01) and male sex (OR 10,343, 95% CI 1078–99,256, p value 0.043) were significantly associated with postoperative ileus after TaTME. Intraabdominal CO2 pressure should be carefully set, as it may represent a risk factor for postoperative ileus in patients undergoing TaTME.
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Metadata
Title
High-pressure CO2 insufflation is a risk factor for postoperative ileus in patients undergoing TaTME
Authors
Michele Grieco
Flavio Tirelli
Annamaria Agnes
Pietro Santocchi
Alberto Biondi
Roberto Persiani
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 6/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-021-01043-1

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