Abdominal Massage After Colon Surgery for Cancer

Postoperative ileus is a transient gastrointestinal dysmotility following abdominal surgery that leads to bloating, abdominal distention, visceral pain, nausea, vomiting, and delayed passage of flatus and stool. This paralytic state lasts longer when surgery involves the distal rather than the proximal digestive tract. Its incidence following colorectal surgery is between 10% and 30%. The main factors of postoperative ileus include age, predisposed constipation, method of anesthesia, type of surgical approach, perioperative analgesia, inflammatory reactions, and the psychopathology of the patient.

Enhanced recovery after surgery (ERAS) provides patients with optimal means to counteract or minimize the deleterious effects of surgery, in particular toward minimizing postoperative ileus. Expert consensus among surgeons, anesthesiologists, physiotherapists, dieticians, and other team members has been reached that stated 24 clinical statements concerning preoperative, peroperative and postoperative periods that should be included in current rehabilitation programs in colorectal surgery.

In China, massage, a 3000-year-old therapy guided by the theory of Yin and Yang, is widely used to treat various diseases. Chapelle and Bowe showed that abdominal massage reduced experimental postoperative ileus in a rat model and suggested that the effect was due to the attenuation of inflammation.

Abdominal massage has not widely been applied after colorectal surgery. Due to the scarcity of literature on abdominal massage, it has never been considered to be part of ERAS recommendations in colorectal surgery. Nevertheless, massage involving profound maneuvering of the viscera through abdominal palpation and breathing has been used as part of the local postoperative protocol in our department for many years with interesting results, and no complication has been reported. To our knowledge, only one study has explored the effect of mechanical abdominal massage on the duration of ileus after colectomy.

The aim of this prospective, multicenter randomized controlled trial (RCT) is to compare return of intestinal transit using the GI-2 criteria as defined by the time to first defecation and time to tolerance of solid food following the operation in two groups of patients following an ERAS protocol for colonic cancer surgery, one with and the other without early postoperative abdominal massage.