Long-term success of modern obstruction treatments in colonic care

Dear Editor, Highlights Systematic clinical evidence into acupuncture for POGD. The need for integrate a systematic analysis of the pathogenesis of POGD with the mechanisms underlying the therapeutic efficacy of acupuncture. The imperative for detailed treatment research to optimizing acupuncture efficacy. We read with great interest the article by Kong et al in the International Journal of Surgery entitled “The effect of acupuncture on gastrointestinal recovery after abdominal surgery: a narrative review from clinical trials”[1]. The authors conducted a narrative review to summarize the progress of clinical research of acupuncture in the treatment of gastrointestinal recovery after abdominal surgery, and discussed the timing of intervention, point selection, and patient benefit along with related issues and operations, providing new insights and prospects for the integrating of acupuncture into the Enhanced Recovery After Surgery (ERAS) protocol. Postoperative ileus (POI)[2] and postoperative nausea and vomiting (PONV)[3] are classified as postoperative gastrointestinal dysfunction (POGD), a common complication after abdominal surgery. The definition and pathogenesis of POI and PONV were first reviewed, and POGD was considered to be related to the use of anesthetic drugs after surgery, surgical trauma and inflammation. The application of acupuncture in ERAS has become a research hotspot in recent years. This article systematically reviews the existing clinical studies on the intervention of acupuncture in the recovery of gastrointestinal function after abdominal surgery. It is concluded that acupuncture has definite curative effect on POGD, and the rule of point selection is summarized. One of the innovations of this review is to discuss possible problems in the clinical application of acupuncture treatment in the perioperative period. This study showed that the timing of acupuncture intervention is crucial for promoting the recovery of gastrointestinal function after abdominal surgery, but most current studies focus on postoperative intervention, and there are few studies on preoperative and intraoperative intervention[4]. In addition, DeQi sensation in acupuncture treatment should also be considered, however, during intraoperative intervention, patients may not be able to accurately report DeQi sensation due to the influence of patients under anesthesia[5]. In addition, acupuncture point selection is also an important issue, the current clinical research often adopts standardized acupoint scheme, but this method is mainly suitable for interpretative clinical research, for other types of research still need to be further explored[6]. These questions raised in this review have high guiding significance for future clinical research. Despite the clear results, we raise questions regarding some factors that may further enhance the conclusions of this study. First, this paper provides a detailed description of the pathogenesis of POGD, but does not systematically analyze the pathogenesis of POGD in conjunction with the mechanism of efficacy of acupuncture treatment. In the Clinical Research part of acupuncture treatment for POGD, a small number of animal mechanism descriptions were interspersed without in-depth discussion. Secondly, this paper does not give specific suggestions for the solution of the problem, but only puts forward some possible directions and problems that need further research. Finally, in clinical practice, the effect of acupuncture treatment is not only related to point selection, DeQi sensation, intervention timing, and patient benefit, but also to the treatment protocol, such as the choice of hand acupuncture or electroacupuncture, the electroacupuncture waveforms, frequency, treatment time, and course of treatment, which all have an impact on the therapeutic effect of acupuncture. Further research is still needed to refine and validate these questions. In summary, this paper innovatively and systematically discussed the acupuncture treatment of gastrointestinal recovery after abdominal surgery, which provides necessary insights for the clinical application of acupuncture treatment and is of great significance for the inclusion of acupuncture in the ERAS protocol.