Abdominal Massage After Colon Surgery for Cancer

Postoperative ileus is a transient gastrointestinal dysmotility following abdominalsurgery that leads to bloating, abdominal distention, visceral pain, nausea, vomiting,and delayed passage of flatus and stool. This paralytic state lasts longer when surgeryinvolves the distal rather than the proximal digestive tract. Its incidence followingcolorectal surgery is between 10% and 30%. The main factors of postoperative ileusinclude 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 counteractor minimize the deleterious effects of surgery, in particular toward minimizingpostoperative ileus. Expert consensus among surgeons, anesthesiologists,physiotherapists, dieticians, and other team members has been reached that stated 24clinical statements concerning preoperative, peroperative and postoperative periods thatshould 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, iswidely used to treat various diseases. Chapelle and Bowe showed that abdominal massagereduced experimental postoperative ileus in a rat model and suggested that the effect wasdue to the attenuation of inflammation.Abdominal massage has not widely been applied after colorectal surgery. Due to thescarcity of literature on abdominal massage, it has never been considered to be part ofERAS recommendations in colorectal surgery. Nevertheless, massage involving profoundmaneuvering of the viscera through abdominal palpation and breathing has been used aspart of the local postoperative protocol in our department for many years withinteresting results, and no complication has been reported. To our knowledge, only onestudy has explored the effect of mechanical abdominal massage on the duration of ileusafter colectomy.The aim of this prospective, multicenter randomized controlled trial (RCT) is to comparereturn of intestinal transit using the GI‐2 criteria as defined by the time to firstdefecation and time to tolerance of solid food following the operation in two groups ofpatients following an ERAS protocol for colonic cancer surgery, one with and the otherwithout early postoperative abdominal massage.