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In systems that try to minimize hospital stay after abdominal surgery, one of the principal limiting factors is the recovery of adequate bowel function, which can delay discharge or lead [...], The duration of postoperative ileus following abdominal surgery is quite variable, and prolonged postoperative ileus is an iatrogenic phenomenon with important influence on patient morbidity, hospital costs and length of stay in hospital. Adequate treatment for prolonged postoperative ileus is important to improve patient morbidity and clinical efficiency. Both clinical and pharmacological management strategies have improved rapidly over the last decade, and appropriate and timely management using multimodal techniques should be used for optimal care. In this review, we define postoperative ileus, describe the pathogenesis and briefly discuss clinical management before detailing potential pharmacologic management options. La duree de l'ileus postoperatoire consecutif a une chirurgie abdominale est assez variable, et l'ileus postoperatoire prolonge est un phenomene iatrogene susceptible d'exercer un impact important sur la morbidite, de meme que sur les couts et la duree du sejour hospitalier. Il est important de traiter adequatement l'ileus postoperatoire prolonge afin de reduire la morbidite et d'ameliorer l'efficacite clinique. Les strategies de prise en charge, tant cliniques que pharmacologiques, se sont rapidement ameliorees depuis une dizaine d'annees; une prise en charge appropriee et precoce faisant appel a des techniques multimodales s'impose pour la prestation de soins optimaux. Dans la presente synthese, nous definissons l'ileus postoperatoire et nous en decrivons brievement la pathogenese et le traitement, avant d'aborder plus en detail les options pharmacotherapeutiques possibles.

Author(s): Holly Etchegary[sup.1] , Elizabeth Dicks[sup.2] , Kathy Watkins[sup.3] , Sabrina Alani[sup.4] and Lesa Dawson[sup.5] Background Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch sndrome (LS), accounts for 3-5% of all [...], Background Women who carry a mutation for Lynch syndrome face complex decisions regarding strategies for managing their increased cancer risks. At present, there is limited understanding of the factors influencing women's prophylactic surgery decisions. Methods As part of an exploratory pilot project, semi-structured interviews were conducted with 10 women who were Lynch syndrome mutation carriers and had made prophylactic surgery decisions. Nine of 10 women had chosen to undergo prophylactic hysterectomy and/or oophorectomy as a means of managing their increased gynecological cancer risks. Results Study findings revealed that surgery decisions were influenced by multiple factors, including demographic variables such as age and parity, as well as psychosocial factors such as cancer worry, in addition to personal and social knowledge of gynecological cancer. While all women were satisfied with their surgery decision, some reported they were not fully informed about the negative impact on their quality of life post-surgery (e.g., complications of surgically-induced menopause), nor about the potential for, or risks and benefits of, hormone replacement therapy. Conclusions Study findings highlight some of the factors associated with prophylactic surgery decisions and women's perceptions about pre-surgical information provision and needs. Suggestions are made for improving the information and support provided to female carriers of a Lynch syndrome mutation. Keywords: Lynch syndrome, HNPCC, Prophylactic surgery, Gynecological