CLIP-trial; CLoser Look Into Postoperative ileus

Postoperative ileus (POI) is a common complication after abdominal surgery. It
is a transit cessation of bowel mobility after surgery and presents as an
inability to tolerate enteral nutrition, associated with nausea, abdominal
distension, and lack of flatus and defecation. Although bowel function
literally recovers within 3 to 5 days after operation, in more than 50% cases
however, it is not fully recovered 4 days post operation. Delayed recovery of
bowel function leads to other serious outcomes such as longer hospitalization,
hospital-acquired infections and pulmonary compromise, and of course results in
a large increase of medical cost as well.

Opening of the peritoneal cavity and manipulation of the peritoneum and bowel
are the main causes of POI. Open procedures significantly delay the recovery of
POI. Other factors such as previous surgery, general anaesthesia and
postoperative opioid consumption also contribute to the prolonged lack of bowel
motility.

Abdominal surgery triggers two different phases: an early neurogenic phase and
a late inflammatory response, the latter of which is considered to be a
clinically more relevant inhibition of gastrointestinal motility. Pathogenenis
of POI have been associated with many clinical conditions, they all contribute
to gasto-intestinal (GI) dysmobility through two common pathways. Firstly the
inhibitory neural reflexes that increase inhibitory sympathetic activity in the
GI tract. Secondly the inflammatory response to intestinal manipulation and
trauma. Local macrophages, activated by intestinal manipulation, produce an
inflammatory response that results in muscle dysfunction. Especially because of
neutrophil infiltration into the intestinal muscularis. Mast cells play also a
role according to the study from De Jonge et al A number of studies
concentrate on the physical, pharmacological, electrical stimulations of the
vagus nerve in order to attenuate POI.

To get a better understanding of the neurolhumoral respons and the effect on
gastrointestinal motility there are several studies which take a close look to
electrogastrography and different inflammatory markers; interleukine (IL)-1,
IL-6, procalcitonine and CRP. Especially IL-1 and -6 seems to play an important
role in the pathogenesis of postoperative ileus. Even little manipulation of
the bowel induce activity of IL-1 and -6. This results in activation of
nitricoxide and prostaglandine, which will cause leucocytes in the circular
muscle of the bowel.

However, no data is available till now to answer if these parameter can be used
to predict or early diagnose POI. In this study we therefore will investigate
the normal values of the different inflammatory parameters after colorectal
operation, and set up the database of these parameters in patient with standard
medical interventions. The aim if this study is to investigate the feasibility
of using inflammatory parameters to predict POI. In addition, this will bring a
control group for studies in the future. This can help to interpretate the
effects of profylactive therapies objectively in the future.

- better understanding of postoperative ileus pathofysiology. Besides it become
possible to estimate the severity of ileus, and development of ileus by
clinical and biochemical parameters.

- achieve a database like a control group for future studies that will use
interventions to treat or prevent ileus

Prospective case control pilot study

There is no serious extra risk or benefit associated with participation in this
trial. We will only one time extra blood from the patient by vena punction.