eP147 - Alvimopan Use After Minimally Invasive Right Colectomy Reduces the Incidence of Postoperative Ileus and Shortens Hospital Length of Stay

Purpose/Background: Postoperative ileus is a vexing problem in colorectal surgery. It prolongs hospital length of stay (LOS) and adds significant costs to patient care. Alvimopan has been used for many years to improve length of stay and reduce the incidence of postoperative ileus (POI) after open colectomies. With the increased use of laparoscopy for colectomies and as enhanced recovery after surgery (ERAS) pathways have matured, the utility of Alvimopan has come into question. Current ERAS guidelines from the American Society of Colon and Rectal Surgeons do not support the use of Alvimopan after minimally invasive colectomy in the setting of an ERAS program. Despite the improvements in outcomes seen with ERAS programs, several retrospective studies have shown that the incidence of postoperative ileus remains high after minimally invasive right colectomy (MIRC) even in the setting of an ERAS program. Our study sought to determine the effect of using Alvimopan on postoperative outcomes after minimally invasive right colectomy in the setting of an ERAS pathway. We hypothesized that Alvimpan would improve postoperative outcomes after robotic or laparoscopic right colectomy by reducing both LOS and the incidence of POI.Methods/Interventions: We retrospectively reviewed our outcomes after MIRC (robotic or laparoscopic) for benign and malignant diseases from 2021-2023. We compared outcomes of patients undergoing MIRC with or without Alvimopan. All patients were placed on a standardized ERAS pathway. We excluded patients who were converted to open surgery. We reviewed the length of stay, incidence of postoperative ileus, readmission rates, and days to return of bowel function.Results/Outcomes: Standard statistical analysis was used to compare outcomes after MIRC with and without the use of Alvimopan. Our chart review included 146 patients. Ninety-three patients were managed as part of a standardized ERAS program but without Alvimopan. Fifty-three patients received standard dose preoperative and postoperative Alvimopan as part of their ERAS pathway. There were no statistically significant differences in patient age (p=0.26) or hospital readmission rates (p=0.33). There was a significant difference between groups with respect to the incidence of POI, LOS, and time to return of bowel function. Patients in the Alvimopan group had a shorter LOS (2.5 days vs 4 days, p=0.0003), reduced incidence of POI (3% vs 5.7%, p=0.033), and earlier return of bowel function (1.8 days vs 2.4 days, p=0.001).Conclusion/

Discussion: Postoperative ileus continues to be a significant issue in the field of colorectal surgery, especially after right colectomy. Minimally invasive surgery is an important adjunct to preventing POI but despite its use, the rate of POI after right colectomy remains significant. Our study demonstrates that the use of Alvimopan as part of an ERAS pathway in patients undergoing a minimally invasive right colectomy significantly reduces the incidence of POI and leads to earlier return of bowel function and earlier discharge of patients to home. Limitations of our study include its retrospective nature, small patient numbers, and some heterogeneity in the use of our ERAS pathway because of surgeon preference. While there is little data to support the use of Alvimopan after laparoscopic colectomy, our study suggests that it has benefit for patients undergoing a minimally invasive right colectomy as part of an ERAS pathway. Future studies should focus on the cost benefits achieved with earlier discharge by using Alvimopan in this select group of patients.Patient Outcomes After Robotic or Laparoscopic Right Colectomy With or Without Alvimopan