Effect Of Preoperative Oral Carbohydrate Intake On Preoperative Gastric Emptying In Patients Undergoing Laparoscopic Cholecystectomy

Part Ⅰ Gastric emptying in patients with cholelithiasis and post-cholecystectomy:measurement by ultrasonography Background Cholelithiasis is a common digestive disorder with a prevalence of 10%and an annual increase of 0.60%to 1.39%.Data show that despite strict adherence to the fasting and abstinence guidelines protocol,13%of patients undergoing LC surgery have a full stomach,an incidence significantly higher than the incidence of full stomach in general surgery patients.Gastric emptying disorder,a syndrome characterized by delayed gastric emptying with non-mechanical obstruction and symptoms such as epigastric distention,nausea and vomiting.Gastric emptying disorders are often secondary to abdominal surgery such as major gastrectomy and pancreaticoduodenectomy,and are more common in patients with diabetes and obesity.Studies have shown that patients with cholelithiasis have decreased gastrointestinal motility due to their own gallbladder stones and surrounding tissue inflammation.Currently,ultrasound technology is becoming more sophisticated and numerous studies have demonstrated the feasibility of measuring gastric contents.The aim of this study was to analyze the gastric motility characteristics of patients with cholelithiasis and post-cholecystectomy and to assess the presence of gastric emptying disorders in order to provide a clinical reference.Objective Evaluation of gastric emptying in patients after cholelithiasis or cholecystectomy,as measured by ultrasonography.Methods Thirty patients with cholelithiasis and post-cholecystectomy and healthy volunteers each,of any gender,aged 18-64 years,with BMI 18-30 kg/m2 and ASA classification I or II,were selected and recorded as the gallstone group(group G),cholecystectomy group(group CH)and control group(group C),respectively.The indigestion scores of the enrolled subjects in the last three months were assessed;the subjects took a semi-solid test meal(300kcal)in the fasting state,and ultrasound was applied to detect the gastric sinus cross-sectional area(CSA)at fasting(T0),at taking The cross-sectional area(CSA)of the gastric sinus at 5,15,30,45,60,90 and 120 min(T1-7)after the test meal was taken,the gastric emptying fraction at 60 min and 90 min was calculated,and the gastric half-emptying time and the remaining area of the gastric sinus at 120 min after the test meal were calculated.Results Compared with group C,dyspepsia scores were significantly higher in group G and group CH in the near March(P<0.05),the cross-sectional area of the gastric sinus was significantly higher from 30 min to 120 min after taking the test meal(T3-7),the gastric emptying fraction was significantly lower at 60 min and 90 min,and the gastric half-emptying time and the remaining area of the gastric sinus at 120 min after taking the test meal were significantly increased compared with the control group(P<0.05).Compared with group G,the cross-sectional area of the gastric sinus was significantly higher in the CH group from 45 min to 120 min(T4-7)after taking the test meal,and was accompanied by a further decrease in gastric emptying fraction at 60 min and 90 min and a significant prolongation of gastric half-emptying time(P<0.05).Conclusion Gastric emptying time was longer in patients with biliary tract disorders compared to healthy subjects after taking a semi-solid test meal and was further prolonged in patients after cholecystectomy.Part Ⅱ Effect of preoperative oral carbohydrate intake on preoperative gastric emptying in patients undergoing laparoscopic cholecystectomyBackground Preoperative oral carbohydrate(POC)is an important component of rapid recovery surgery and has numerous advantages,such as reducing the incidence of nausea and vomiting,alleviating insulin resistance,and shortening the length of hospital stay.The latest ERAS protocol recommends that adult patients with no significant contraindications consume 800 ml of 12.5%carbohydrate 10 h before elective surgery and 400 ml 2 h before surgery,but many clinicians are still skeptical about the safety of POC in clinical practice,believing that it increases the risk of perioperative reflux aspiration and impaired gastric emptying,especially in patients who are obese,diabetic,pregnant,or with previous abdominal disorders.Patients with co-morbid abdominal disorders.Even though the latest guidelines of the European Society of Anaesthesiology state that oral carbohydrates are safe before elective surgery in patients with obesity,gastroesophageal reflux disease,diabetes mellitus,and pregnancy,the use of POC in patients with cholelithiasis undergoing laparoscopic cholecystectomy(LC)may cause delayed gastric emptying and increase the risk of anesthesia-induced reflux aspiration.However,in patients with cholelithiasis undergoing laparoscopic cholecystectomy(LC),it is not clear from the guidelines whether the use of POC may cause delayed gastric emptying and increase the risk of inadvertent reflux during the induction period.Objective To evaluate the effect of preoperative oral carbohydrate on gastric emptying in patients with laparoscopic cholecystectomy.Methods One hundred patients undergoing the first elective laparoscopic cholecystectomy from November 2021 to March 2022 on the same day,of any gender,age 18-64 years,BMI 18-30 kg/m2,ASA classification Ⅰ-Ⅱ,were selected and divided into 2 groups(n=50)using the random number table method:control group(group C,)and preoperative oral carbohydrate group(group P)).Patients in both groups were abstained from solid food after 20:00 p.m.before surgery and from drinking after 21:30 p.m.in group C.Group P received 800 ml of 12.5%preoperative oral carbohydrate at 21:30 a.m.and 400 ml of preoperative oral carbohydrate from 5:00 a.m.to 5:30 a.m.All patients underwent ultrasound examination of the gastric sinus at 7:30 a.m.(T1)to determine the nature of gastric contents according to the qualitative analysis of images,and Perlas classification was performed,and the cross-sectional area(CSA)of the gastric sinus was calculated in both the supine and right lateral decubitus position(RLDP),and gastric volume(GV)and gastric volume to weight ratio(GV/W)were calculated.For solids in the stomach or GV>1.5 ml/kg was defined as a full stomach.Patients assessed as a full stomach at T1 underwent antrum ultrasonography again before induction of anesthesia(8:30 a.m,T2).The occurrence of satiety at T1 and T2 in each group was recorded,and subjective VAS score was performed at T2,and adverse reactions such as reflux aspiration,24h postoperative nausea and vomiting,postoperative first intestinal exhaust time and postoperative total hospital stay were recorded.Results Compared with group C,group P at T1 had significantly higher rates of semisitting CSA,RLDP CSA,GV,GV/W,Perlas grade,and full stomach(P<0.05).At T2,there was no statistical difference in the incidence of satiation between the two groups.Patients’subjective comfort VAS scores in group P increased significantly,and the incidence of postoperative nausea and vomiting decreased significantly and the time of first postoperative venting was significantly earlier(P<0.05)Conclusion Delayed gastric emptying after preoperative oral carbohydrate administration in laparoscopic cholecystectomy patients showed an increased incidence of satiety 2h after carbohydrate administration,but the incidence of satiety after 3h was comparable to that of the conventional fasting and drinking regimen group,suggesting that the time window for oral carbohydrate administration can be appropriately shifted forward(e.g.3h preoperatively)when preoperative POC treatment is performed.