Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection

• Published in: British journal of surgery 2010-08, Vol.97 (8), p.1198-1206
• Main Authors: Hendry, P. O., van Dam, R. M., Bukkems, S. F. F. W., McKeown, D. W., Parks, R. W., Preston, T., Dejong, C. H. C., Garden, O. J., Fearon, K. C. H.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Biological and medical sciences; Dietary Supplements; Energy Intake; Female; Gastric Emptying; General aspects; Humans; Laxatives - administration & dosage; Length of Stay; Liver - surgery; Liver Diseases - physiopathology; Liver Diseases - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Magnesium Hydroxide - administration & dosage; Male; Medical sciences; Middle Aged; Postoperative Care; Prospective Studies; Recovery of Function; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.7120

Background: Routine laxatives may expedite gastrointestinal recovery and early tolerance of food within an enhanced recovery after surgery (ERAS) programme. Combined with carbohydrate loading and oral nutritional supplements (ONS), it may further enhance recovery of gastrointestinal function and promote earlier overall recovery. Methods: Seventy‐four patients undergoing liver resection were randomized in a two‐by‐two factorial design to receive either postoperative magnesium hydroxide as a laxative, preoperative carbohydrate loading and postoperative ONS, their combination or a control group. Patients were managed within an ERAS programme of care. The primary outcome measure was time to first passage of stool. Secondary outcome measures were gastric emptying, postoperative oral calorie intake, time to functional recovery and length of hospital stay. Results: Sixty‐eight patients completed the trial. The laxative group had a significantly reduced time to passage of stool: median (interquartile range) 4 (3–5) versus 5 (4–6) days (P = 0·034). The ONS group showed a trend towards a shorter time to passage of stool (P = 0·076) but there was no evidence of interaction in patients randomized to the combination regimen. Median length of hospital stay was 6 (4–7) days. There were no differences in secondary outcomes between groups. Conclusion: Within an ERAS protocol for patients undergoing liver resection, routine postoperative laxatives result in an earlier first passage of stool but the overall rate of recovery is unaltered. Registration number: NCT00538954 (http://www.clinicaltrials.gov). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Limited clinical value