Alvimopan As Adjunct to Fast-track Management to Further Reduce Postoperative Ileus and Hospital Length Stay in Open Versus Laparoscopic Colectomy

Alia Abdulla, DO, Gretchen Aquilina, DO, Devin Flaherty, DO, Roy Sandau, DO, Larry Cohen, DO, Marc Neff, MD. UMDNJSOM


Introduction: Post-Operative Ileus (POI) is a common complication of abdominal surgeries leading to increased hospital stay and healthcare costs. Fast-track management has been employed to avert this complication and can aid in reduction of these costs. Alvimopan is a novel agent in which competitively binds to peripheral mu-opioid receptor in the gastrointestinal tract. Following oral administration, alvimopan antagonizes the peripheral effects of opioids on gastrointestinal motility. Use of this drug during laparoscopic colon surgery may shorten hospital length stay by reducing the incidence of POI.
Methods: A retrospective review was conducted to evaluate the effectiveness of using alvimopan and comparing the return of bowel function in open versus laparoscopic colon surgery. Alvimopan (12mg) was administered to patients at least 30 minutes prior to undergoing colon surgery and the drug was continued during the hospital stay (12mg twice daily). The postoperative course was followed and return of bowel function and length of stay was recorded.
Results: One-hundred and sixteen patients underwent laparoscopic colon surgery and received alvimopan during the period of Jan 1 2009 to December 31, 2010. BMI ranged from 25 to 40. The patients received one of four colon surgeries (laparoscopic low anterior resection, laparoscopic right hemicolectomy, laparoscopic sigmoid resection, or laparoscopic colostomy reversal). The return of bowel function with regards to passage of flatus was 1-5 days (ave 2.2d). The full resolution of ileus with passage of stool was 1-6 days (ave 3.7d). The length of stay was 1-6 days (ave 3.2d).
Conclusion: Alvimopan can be employed as an adjunct to fast-track management in order to significantly reduce the incidence of POI with return of bowel function as quickly as postoperative day 1 in open versus laparoscopic colon surgery. This in turn reduces length of stay in the hospital. It should be considered additive to the reduction in post-operative ileus seen with fast-track management and laparoscopic surgery.

Session Number: Poster – Poster Presentations
Program Number: P136
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