Study of the Effect of Water Soluble Oral Contrast (Gastrografin) on Postoperative Ileus After Colorectal Surgery

• Hospital stay after diagnosis of ileus [ Time Frame: While the patient is admitted to the hospital. An average of 11 days since the intervention. ] [ Designated as safety issue: Yes ]
  Postoperative complications were assessed in the intervening period between the immediate postoperative phase and when the patient is discharged.
• Percentage of patients requiring total parenteral nutrition. [ Time Frame: While the patient is admitted to the hospital. An average of 11 days since the intervention ] [ Designated as safety issue: Yes ]
  Postoperative complications were assessed in the intervening period between the immediate postoperative phase and when the patient is discharged
• Presence of postoperative pain and analgesic required [ Time Frame: While the patient is admitted to the hospital. An average of 11 days since the intervention ] [ Designated as safety issue: Yes ]
  Postoperative complications were assessed in the intervening period between the immediate postoperative phase and when the patient is discharged
• Percentage of mortality during hospitalization. [ Time Frame: While the patient is admitted to the hospital. An average of 11 days since the intervention ] [ Designated as safety issue: Yes ]
  Postoperative complications were assessed in the intervening period between the immediate postoperative phase and when the patient is discharged

The purpose of this trial is to determine whether the water-soluble contrast (gastrografin) is more effective in the treatment of postoperative ileus than the conventional one.

• Drug: Gastrografin
  Administration of 100 ml of gastrografin by the nasogastric tube, only once.
• Drug: physiological serum
  Administration of 100 ml of physiological serum 0,9% by the nasogastric tube, only once.

• Experimental: Gastrografin
  Patients located in this group will be treated with the administration of 100 ml of gastrografin by the nasogastric tube, only once, after the diagnosis of postoperative ileus.
  Intervention: Drug: Gastrografin
• Placebo Comparator: physiological serum
  Patients included in this group will be treated with 100 ml of physiological serum 0,9% by the nasogastric tube, only once, after the diagnosis of postoperative ileus.
  Intervention: Drug: physiological serum

• Chen JH, Hsieh CB, Chao PC, Liu HD, Chen CJ, Liu YC, Yu JC. Effect of water-soluble contrast in colorectal surgery: a prospective randomized trial. World J Gastroenterol. 2005 May 14;11(18):2802-5.
• Biondo S, Parés D, Mora L, Martí Ragué J, Kreisler E, Jaurrieta E. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg. 2003 May;90(5):542-6.
• Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg. 2007 Apr;94(4):404-11. Review.
• Delaney CP, Wolff BG, Viscusi ER, Senagore AJ, Fort JG, Du W, Techner L, Wallin B. Alvimopan, for postoperative ileus following bowel resection: a pooled analysis of phase III studies. Ann Surg. 2007 Mar;245(3):355-63.
• Waldhausen JH, Schirmer BD. The effect of ambulation on recovery from postoperative ileus. Ann Surg. 1990 Dec;212(6):671-7.
• Böhm B, Milsom JW, Fazio VW. Postoperative intestinal motility following conventional and laparoscopic intestinal surgery. Arch Surg. 1995 Apr;130(4):415-9.
• Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg. 2000 Nov;87(11):1480-93. Review.

Inclusion Criteria:

• All patients with postoperative ileus after colorectal surgery, defined as the presence from the third postoperative day, abdominal distension, nausea, vomiting with or without abdominal pain or discomfort by dilation of bowel loops, confirmed radiology of the abdomen, and which are: Age > 18 years Patients undergoing laparotomy or laparoscopy for the following variants of colorectal disease with or without stoma:

  1. Neoplasia.
  2. Inflammatory disease.
  3. Diverticular disease. Patients who have been treated with standard PCA as postoperative analgesia. Signed informed consent. Undergoing elective or scheduled

Exclusion Criteria:

• Patient's refusal to sign informed consent
• Pregnancy or lactation

• Hypersensitivity to iodinated contrast agents (it´s the only contraindication to oral Gastrografin) Presence of other problems that justify the etiology of postoperative ileus:

  1. Anastomotic leakages.
  2. Mesenteric vascular disease.
  3. Incarcerated hernias.
  4. Intra-abdominal abscesses or collections.
  5. Metabolic or electrolyte disturbances. If during the course of the study one of the reasons previously cited as the etiology of postoperative ileus is present, the patient shall also be excluded. Also excluded patients undergoing emergency surgery.