Abstract
Author(s): Fouad Aoun,Marc Zanaty,Alexandre Peltier,and Rolandvan Velthoven
Postoperative ileus (POI) is the most common cause of prolonged length of hospital stays (LOS) and associated healthcarecosts.Theadventofminimalinvasivetechniquewasamajorbreakthroughintheurologiclandscapewithgreatpotential toprogressinthefuture.Intheï¬eldofgastrointestinalsurgery,severalstudieshadreportedlowerincidenceratesforPOIfollowing minimalinvasivesurgerycomparedtoconventionalopenprocedures.Incontrast,littleisknownabouttheeï¬ectofminimalinvasive approachontherecoveryofbowelmotilityafterurologicsurgery.Weperformedanoverviewofthepotentialbeneï¬tofminimal invasiveapproachonPOIforurologicprocedures.ThemechanismsandriskfactorsresponsiblefortheonsetofPOIarediscussed with emphasis on the advantages of minimal invasive approach. In the urologic ï¬eld, POI is the main complication following radicalcystectomybutitisrarelyofclinicalsigniï¬canceforotherminimalinvasiveinterventions.Laparoscopyorroboticassisted laparoscopictechniqueswhenstudiedindividuallymayreducetotheirownthedurationandpreventtheonsetofPOIinasubset ofprocedures.Thepotentialinï¬uenceofageandurinarydiversiontypeonpostoperativeileusiscontradictoryintheliterature. ThereissomeevidencesuggestingthatBMI,bloodloss,urinaryextravasation,existenceofamajorcomplication,bowelresection, operativetimeandtransperitonealapproachareindependentriskfactorsforPOI.TreatmentofPOIremainselusive.Oneofthe mostimportantandeï¬ectivemanagementstrategiesforpatientsundergoingradicalcystectomyhasbeenthedevelopmentanduse ofenhancedrecoveryprograms.AnoptimalrationalstrategytoshortenthedurationofPOIshouldincorporateminimalinvasive approachwhenappropriateintomultimodalfasttrackprogramsdesignedtoreducePOIandshortenLOS.
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