Prospective comparison of gastric emptying after laparoscopic-aided colectomy versus open colectomy

Laparoscopic colectomy has been associated with a shorter postoperative ileus when compared to open colectomy, although the mechanism is unclear. This study is designed to evaluate gastric emptying following open colectomies (OC) versus laparoscopic-aided colectomies (LAC) using serial serum acetaminophen levels (ACE), which correlate with gastric emptying. The study groups were limited to patients undergoing either right or left colectomy who received general anesthetic. Patients with diabetes mellitus or other colon resections were excluded. Postoperative analgesia was provided with intramuscular ketorolac and opioids for breakthrough pain. Patients received 500 mg ACE at 24 and 48 hours postoperatively, and ACE levels were measured 5, 10, 20, 30, 45, 60, 90, and 120 minutes following ingestion. The OC and LAC groups were matched in terms of operation performed. There were multiple carcinomas in the OC group, and none in the LAC group. Normal control values were also obtained for ACE absorption curves. Of all the time intervals tested at both 24 and 48 hours, there was only a single time interval (30 minutes at the 48-hour testing interval) in which there was a significant difference between the OC and LAC groups. In both the OC and LAC groups, there were multiple time intervals when the ACE levels were significantly different when compared to controls. The results indicate no significant difference in gastric emptying as measured by acetaminophen absorption in postoperative colectomy patients. Therefore, although laparoscopic patients have a clinically shorter postoperative ileus, the mechanism for this reduction appears unrelated to gastric emptying.