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Colorectal Dis. 2019 Jul 25. doi: 10.1111/codi.14788. [Epub ahead of print]

Feasibility of perioperative volatile organic compound breath testing for the prediction of paralytic ileus following laparoscopic colorectal resection.

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Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK.
Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK.
Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Level 10, Praed Street, London, W2 1NY, UK.
Faculty of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK.
Institute of Bio-Sensing Technology, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, United Kingdom.



Despite implementation of enhanced recovery after surgery (ERAS) and laparoscopic techniques postoperative ileus (POI) remains frequent after colorectal surgery impacting the patient, their recovery and healthcare resources. Presently there are no tests that reliably predict or enable early POI diagnosis. Volatile organic compounds (VC) are products of human and microbiota cellular metabolism and we hypothesised that a detectable alteration occurs in POI.


This was a prospective observational study of patients undergoing laparoscopic colorectal resection within an established ERAS programme. Standardised end expiratory breath sampling was performed on the morning of surgery and the first three post-operative mornings. VC concentrations were analysed using Selected Ion Flow Tube Mass Spectrometry and GastroCH4 ECKĀ®. Feasibility data, bowel preparation, post-operative oral intake, POI and 30-day morbidity were recorded.


Of the 75 potentially eligible patients, 58 (77%) agreed to participate. Per-protocol breath sampling was successfully completed in 94%. There were no analytical failures. Baseline and post-operative VC levels were broadly comparable and were not altered by bowel preparation or post-operative oral intake. POI developed in 14 (29%) patients. Pre-operative ammonia concentration was higher in POI patients (830ppb vs. 510ppb, P=0.027). There was an Increase in acetic acid at day two in patients who developed POI (99ppb vs 171ppb, p=0.021).


Repeated VC breath sampling and analysis is feasible in the peri-operative setting. Morning of surgery ammonia concentration may be a potential predictor of POI. This article is protected by copyright. All rights reserved.


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