Postoperative Gas

After an abdominal operation gas generally forms in the intestines, balloons the abdomen, causes the patient excruciating agony for many hours. How to prevent such postoperative gas pains was the subject of two articles by surgeons in last week's American Journal of Surgery.

Dr. Louis Emmet Mahoney of Los Angeles prevents gas pains by giving patients all the food which they can comfortably eat right after their operations. His theory: "The human intestinal tract is a muscular tube, the mucous membrane of which secretes digestive ferments and the motility of which is largely dependent upon these ferments and the presence and character of the food material in the bowel. Activity of the liver, the chemical engine of the body, and the secretion of bile is greatly influenced by the amount and the variety of ingested food. Whenever starvation supervenes, and the usual hospital liquid diet is really semistarvation, the bacteria normally present in the bowel increase enormously and produce large amounts of flatus. If lack of the food to which the upper bowel is accustomed continues for more than a very few hours, those species of bacteria normally resident in the colon and cecum ascend into the ileum and jejunum and there proliferate giving rise to huge amounts of gas and to symptoms of toxemia from absorption."

Dr. Mahoney's practice: "Patients are urged to eat solid food very soon after operation, usually the next morning. If not nauseated, they are served a tray the evening of the operative day and encouraged to partake of dry toast, jello, Cream of Wheat and similar articles. Water is permitted by mouth in such amounts as the patient may desire as soon as the nausea has disappeared. When ethylene or spinal anesthesia has been employed, this is usually within one or two hours after the return from the operating room. Where ether has been used, water is ordinarily taken two to four hours afterwards. . . . Fruit juices of all varieties are strictly interdicted as it is felt that they have little or no caloric value and produce intestinal fermentation and resultant gas formation.

"Besides the early feeding of water and solid food by mouth, it is also extremely helpful to supply some adjuvant which will furnish bulk, retard bacterial growth and thus help to combat intestinal stasis. This purpose is best served by mineral oil in agar, with or without the addition of phenolphthalein. . . ."

Drs. William Russell Levis & Edward Lewis Axelman of Philadelphia call theirs a "Modern Method for Prevention of Postoperative Distention." They depend upon a newly synthesized drug to keep the bowels moving and expelling any gas which may form. The drug: dimethyl-carbamic ester of 3-hydroxyphenyl-trimethyl ammonium methyl-sulphate, a chemical compound which has been telescoped to prostigmin. Drs. Levis & Axelman inject small amounts of prostigmin "at the time of operation or shortly thereafter and continue injections for 24 to 48 hours at four to six hour intervals, or until such time that we feel the condition of the patient indicates no further need of this medication. The last injection of prostigmin is followed by a soapsuds enema."

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