Early TEAS Combined with Simethicone for Accelerated Gastrointestinal Recovery after Prostate Cancer Surgery: A  case-control study

Early TEAS Combined with Simethicone for Accelerated Gastrointestinal Recovery after Prostate Cancer Surgery: A case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early TEAS Combined with Simethicone for Accelerated Gastrointestinal Recovery after Prostate Cancer Surgery: A case-control study qiuxia qin, Juan liu, duo zhang, hongjiao wang, xiaoqin xie, lijuan nie, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8669687/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction Postoperative gastrointestinal dysfunction is a common complication following laparoscopic radical prostatectomy, significantly impairing patient recovery. Timely pharmacological and physical interventions can effectively promote gastrointestinal function recovery. This study aimed to evaluate the efficacy of early transcutaneous electrical acupoint stimulation (TEAS) combined with oral simethicone in alleviating postoperative abdominal distension in prostate cancer patients, providing evidence for optimizing the timing and methods of postoperative interventions. Materials and methods A retrospective analysis was conducted on 138 patients who underwent radical prostatectomy at a hospital in Wuhan from February 2025 to November 2025. All cases were from the same surgical team and were divided into three groups based on medical orders: (1) Control group (n=46, standard care), (2) TEAS + simethicone group (n=46, TEAS and simethicone initiated on postoperative day 1), and (3) Early TEAS + simethicone group (n=46, TEAS and simethicone initiated immediately after surgery). Outcome measures included abdominal distension severity on postoperative days 1–3, time to first flatus, defecation within 3 days, and incidence of postoperative nausea and vomiting (PONV). Results Regarding abdominal distension: On the first postoperative day, there was no significant difference in the severity of abdominal distension among the three groups ( P > 0.05); on the second postoperative day, the incidence of abdominal distension in the early electrical stimulation combined group (21.74%) was lower than that in the control group (45.65%), and the number of patients with severe abdominal distension (6.52%) was also lower than that in the control group (28.26%); on the third postoperative day, the incidence of abdominal distension in the electrical stimulation combined group (21.74%) and the early electrical stimulation combined group (23.91%) was significantly lower than that in the control group (42.48%), and the difference was statistically significant ( P < 0.01). Regarding the time of first defecation: There was a statistically significant difference among the three groups of patients. The early electrical stimulation combined group (22.07 ± 9.27 hours) was significantly shorter than the control group (28.33 ± 11.85 hours); in terms of the number of patients defecating on the third postoperative day: There was a difference among the three groups of patients. The early electrical stimulation combined group (30.43%) had more patients than the control group (10.87%); in terms of the incidence of nausea and vomiting: There was no statistically significant difference among the three groups of patients ( P > 0.05). Conclusions Early TEAS combined with oral simethicone effectively reduces postoperative abdominal distension, accelerates gastrointestinal recovery, and promotes earlier bowel movements in prostate cancer patients. These findings suggest that combined pharmacological and physical therapy should be initiated as early as possible to improve postoperative gastrointestinal dysfunction. Prostate cancer Laparoscopy Abdominal distension Transcutaneous electrical acupoint stimulation (TEAS) Simethicone Early intervention Figures Figure 1 Figure 2 Introduction Prostate cancer is the second most common malignancy in men, with a rising global incidence [1]. Laparoscopic radical prostatectomy (LRP) under general anesthesia has become the gold standard for treating localized prostate cancer [2]. Post-laparoscopic abdominal distension occurs in 15–30% of cases, with 3–8% progressing to severe complications such as postoperative ileus (POI) requiring intervention [3,4]. Abdominal distension exacerbates incisional pain, delays wound healing, impairs sleep quality, and may lead to prolonged recovery and hospitalization, imposing significant physical and psychological burdens on patients [5]. Given the proximity of prostatectomy incisions to the abdominal and pelvic regions, distension is a critical factor affecting wound healing and postoperative pain. Recent guidelines classify post-prostatectomy abdominal distension as a Grade 2 complication, highlighting its importance in Enhanced Recovery After Surgery protocols [6]. The etiology of post-laparoscopic distension is multifactorial, involving surgical factors, patient-related variables, and postoperative management [7]. Historically, postoperative gastrointestinal dysfunction (POGD) was considered inevitable, but emerging evidence suggests it is modifiable [8]. Current interventions include pharmacological and physical therapies [9]. Simethicone, a stable surfactant approved by the FDA in 1952 [10], is widely used in gastroscopy. A 2010 single-center pilot study demonstrated its efficacy in alleviating post-laparoscopic distension [11], though its mechanism and broader applicability remain under investigation.In 2024, a multicenter clinical trial involving 1,520 participants confirmed that simethicone was an independent predictor of bloating relief after laparoscopic cholecystectomy (OR = 1.89, P < 0.001). In this study, all patients received oral simethicone at six hours postoperatively, further validating the efficacy and safety of early postoperative administration [12]. However, the study did not explore different timing intervals for intervention, leaving it unclear whether earlier versus later administration of simethicone would yield different effects on bloating. The 2021 Expert Consensus on POGD Management strongly endorsed traditional Chinese medicine (TCM) therapies, including acupuncture, acupressure, and electroacupuncture [13]. TEAS integrating TCM theory with modern electrotherapy, delivers pulsed currents via cutaneous electrodes [14]. Preliminary studies support its role in accelerating postoperative gastrointestinal recovery [15]. With advancements in ERAS protocols, early TEAS has gained attention for its potential to enhance recovery. Evidence suggests that TEAS administered within 24 hours post-cesarean section or immediately after laparoscopic cholecystectomy promotes faster gut motility restoration [16,17]. As hospital stays for prostatectomy patients shorten and same-day surgeries increase, optimizing early interventions is crucial for resource utilization and patient-centered care [18]. In summary, while simethicone and TEAS have demonstrated individual efficacy in postoperative recovery, data on optimal timing and combined interventions remain scarce. Most studies rely on static, single-timepoint assessments of distension severity, limiting clinical applicability. Given the dynamic nature of postoperative distension, this retrospective cohort study compares conventional care, simethicone + TEAS, and early simethicone + TEAS to establish evidence-based guidelines for postoperative abdominal distension management. Methods Study design Inclusion and exclusion criteria This retrospective study analyzed medical records of prostate cancer patients who underwent laparoscopic radical prostatectomy at Tongji Hospital, Wuhan, China between February and November 2025. All cases were performed by the same surgical team. Patients were divided into three groups based on postoperative orders: (1) Control group (no simethicone or transcutaneous electrical acupoint stimulation [TEAS] prescribed); (2) TEAS+simethicone group (both interventions initiated on postoperative day 1); and (3) Early TEAS+simethicone group (interventions administered on the operative day). Inclusion Criteria: Eligible patients met all following criteria: (1) Complete medical documentation including present illness history (demographics, medication history, diagnostic process), past medical history (GI disorders), anesthesia records (operative time, surgical approach, analgesic pump usage), temperature charts (bowel movements), physician orders (simethicone/TEAS administration timing/frequency, enema use), nursing records (TEAS implementation), and ERAS compliance forms (abdominal distension, nausea/vomiting, flatus); (2) Confirmed prostate cancer diagnosis[19]; (3) Underwent laparoscopic radical prostatectomy during hospitalization; (4) Received daily TEAS with ≥6 total sessions. Exclusion Criteria: Patients were excluded for: (1) Pelvic floor dysfunction (documented in medical history); (2) Pre-existing GI motility disorders; (3) Use of other intestinal motility-modulating drugs within 1 month preoperatively or during hospitalization. Sample Size and Ethics Sample size calculation: Utilizing G-power software for a three-group ANOVA sample size estimation, with an effect size f = 0.25, α = 0.05, and Power = 0.8, the minimum required sample size was determined to be 135, with at least 45 subjects per group. A preliminary screening identified 142 medical records, of which 4 were excluded based on inclusion and exclusion criteria (2 due to incomplete data, 2 owing to electrical stimulation administered for fewer than 3 days). The final valid sample comprised 46 subjects per group, resulting in a total of 138 cases.This study was approved by the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (TJ-IRB202502036). Setting and intervention Prior to medical record extraction, a survey was conducted with two prescribing physicians, which revealed that the issuance of medical orders was influenced by both the availability of sufficient time for order placement and individual practice patterns. Specifically, one physician routinely prescribed both electrical stimulation and simethicone, while the other did not. Based on whether the medical orders included simethicone and electrical stimulation as required, three distinct intervention protocols were established, with nurses implementing the corresponding measures according to the physician orders. The control group received standard care, which included: (1) Room temperature adjustment to 22–26°C; (2) Dietary and activity guidance: On postoperative day 1, the assigned nurse assisted patients in ambulation and provided standardized education on diet and fluid intake daily; (3) Psychological support: Assessment of abdominal distention severity, explanation of its potential duration, and alleviation of patient anxiety. The Transcutaneous Electrical Acupoint Stimulation (TEAS) combined with simethicone group received additional interventions beyond the standard care: (1) TEAS equipment: A low-frequency neuromuscular stimulator (model: Biostim base; registration no.: Guangdong Medical Device Approval 20182260716; manufacturer: Foshan Shanshan Datang Medical Technology Co., Ltd.). Indications: Promotion of local blood circulation, pain relief, and neuromuscular excitation. (2) TEAS electrode placement and parameters: One pair of electrodes applied to the Zusanli (ST36) acupoint on the leg (frequency: 20–30 Hz, pulse width: 300–500 μs); another pair placed over the transverse and descending colon, maintaining a distance >2 cm from the surgical incision (frequency: 20–30 Hz, pulse width: 300 μs, current intensity adjusted to patient comfort without pain) [14]. (3) TEAS intervention schedule: Initiated on postoperative day 1, administered twice daily for 3 consecutive days (total 6 sessions), each session lasting 30 minutes [14]. (4) Simethicone administration: Patients were instructed to initiate oral simethicone (3 mL three times daily) starting on postoperative day 1. The early TEAS combined with simethicone group received accelerated interventions: (1) TEAS parameters and electrode placement identical to the TEAS+simethicone group; (2) TEAS timing: One session administered on the day of surgery, followed by twice-daily sessions for 3 consecutive days (total 7 sessions), as per medical orders; (3) Simethicone regimen: Initial dose (3 mL) administered 6 hours postoperatively, followed by 3 mL three times daily (total 10 doses). The study design flowchart is shown in Figure 1. Outcome Measures Evaluation Methods for Gastrointestinal Function Recovery Outcomes This study assessed gastrointestinal recovery using three parameters (abdominal distension, time to first flatus, and defecation within 3 postoperative days) recorded in the Enhanced Recovery After Surgery (ERAS) checklist. While first flatus and defecation were objective outcomes documented by nurses through patient interviews, no standardized objective measure exists for postoperative distension. We therefore developed an evidence-based assessment protocol through literature review, two expert panel meetings, and pilot testing. According to Practical Diagnosis and Therapy in Integrated Traditional Chinese and Western Medicine [20], comprehensive evaluation incorporated six dimensions: distension, abdominal pain, palpation, bowel sounds, flatus, and defecation. Distension severity was determined through dual clinician-patient assessment [21], categorized into four grades per China's Clinical Research Guidelines for New Chinese Medicine Drugs [22] based on symptom reports and umbilical circumference measurements. Abdominal Distension Assessment Methods Physical Examination: A standardized evaluation was performed, beginning with patient-reported symptoms, followed by systematic examination: inspection (abdominal distension and diaphragmatic breathing), auscultation (bowel sounds), superficial palpation (1–2 cm depth at supra-/infra-umbilical regions, avoiding wounds), percussion, and measurement of baseline/daily umbilical circumference. (2) Assessment Method: Daily evaluations (8:30–9:00 AM) were conducted with patients in the supine position, integrating findings from inspection, auscultation, palpation, percussion, and measurements with patient reports to assign distension grades. (3) Result Adjudication: Two geriatric-trained nurses independently graded distension; discrepancies were resolved by the attending physician. Distension Grading Criteria (1) None: No discomfort; no functional impact; stable abdominal girth. (2) Mild: Slight tenderness on palpation; flat abdomen; preserved diaphragmatic breathing; minor sleep/activity interference. (3) Moderate: Mild tenderness; palpable bloating; reduced diaphragmatic breathing; significant functional impairment. (4) Severe: Marked tenderness; pronounced distension; absent/diminished diaphragmatic breathing; profound functional limitation; ≥2 cm girth increase. PONV Assessment Methods Nausea and vomiting were evaluated according to the World Health Organization (WHO) grading criteria [23]: Grade 0: No nausea or vomiting. Grade 1: Mild nausea or abdominal discomfort without vomiting. Grade 2: Transient vomiting (≤1 episode). Grade 3: Vomiting requiring antiemetic medication (≤2 episodes). Grade 4: Intractable vomiting (≥3 episodes) unresponsive to medication. Nurses regularly assessed patients' symptoms and recorded the frequency of vomiting during the first 3 postoperative days on the ERAS checklist. Quality Control Measures To ensure data reliability, all study data were collected from a single department and ward to minimize confounding factors. Two specialized nurses, blinded to the patients' intervention groups, were responsible for data collection. Prior to the study, they underwent standardized training and assessment on abdominal distension evaluation, achieving an inter-rater reliability (Cohen's Kappa coefficient) of 0.81. Additionally, two independent staff members performed dual data entry and automated validation checks to prevent human errors in data recording. Data analysis Measures Statistical analysis was performed using SPSS 25.0 software. Normally distributed continuous data were presented as frequencies and percentages, with one-way ANOVA used for comparing means among three groups. Categorical variables were analyzed using chi-square tests, and multiple comparisons were adjusted with Bonferroni correction. The significance level was set at α = 0.05. Results Baseline data During this study, a total of 142 medical records were collected. Based on the predefined inclusion and exclusion criteria, 4 records were excluded from the final analysis. A total of 4 cases were excluded: 2 due to incomplete medical records, 2 with pre-existing gastric conditions. These exclusions were deemed non-influential based on: (1) Baseline equivalence: No differences in age/sex between excluded and included cases (all p>0.05) (2) Weight assessment: Exclusions represented only 2.8% (4/142) of eligible cases (5% threshold). The study recorded no adverse events associated with either simethicone administration or electrical stimulation interventions. Final analysis included 46 complete medical records per study group, with all three groups demonstrating balanced baseline characteristics (Table 1). Table 5. Multiple comparisons of time to first flatus among three groups Group Mean difference Standard error P 95% CI Group 1 Group 2 3.935 2.379 0.100 -0.771 ～ 8.640 Group 3 6.271 * 2.379 0.009 * 1.566 ～ 10.977 Group 2 Group 1 -3.953 2.379 0.100 -8.640 ～ 0.771 Group 3 2.337 2.379 0.328 -2.368 ～ 7.042 Group 3 Group 1 -6.271 * 2.379 0.009 * -10.977 ～ -1.566 Group 2 -2.337 2.379 0.328 -7.042 ～ 2.368 Note. *= P < 0.0167. Group 1: Control group; Group 2: TEAS combined with simethicone group; Group 3: Early TEAS combined with simethicone group. Table 6. Multiple comparisons of Defecation among three groups Comparison groups χ² P Group 1 vs Group 2 7.143 0.024 Group 2 vs Group 3 8.722 1.000 Group 1 vs Group 3 0.053 0.009 * Note. *= P < 0.0167. Group 1: Control group; Group 2: TEAS combined with simethicone group; Group 3: Early TEAS combined with simethicone group. Discussion Postoperative abdominal distension significantly impairs recovery in prostate cancer patients, with its incidence influenced by multiple factors including age, surgical approach, medication, activity level, and diet [24]. Older age and prolonged operative duration are associated with a higher incidence of abdominal distension. This study demonstrated that TEAS combined with simethicone effectively alleviated abdominal distension and accelerated bowel movement resumption. Early intervention with TEAS and simethicone not only promoted faster defecation but also showed superior efficacy in reducing abdominal distension and facilitating early flatus. No adverse effects related to electrical stimulation or medication were reported, confirming the safety and efficacy of early postoperative TEAS combined with simethicone administration. The findings provide both theoretical and practical insights for postoperative gastrointestinal dysfunction management. Theoretically, this study elucidates the temporal pattern of postoperative distension and the benefits of early intervention, enhancing our understanding of the surgical stress response following laparoscopy and contributing critical parameters for predictive models of gastrointestinal recovery. Practically, the combined physical (TEAS) and pharmacological (simethicone) approach demonstrated significant efficacy in accelerating postoperative gastrointestinal function recovery. Given its favorable safety profile and patient tolerance, this strategy holds substantial clinical and economic value by optimizing healthcare resource utilization and reducing hospital stays. The present study revealed a high incidence and prolonged duration of postoperative abdominal distension in prostate cancer patients, exhibiting a distinct temporal pattern. In the control group, the number of patients experiencing abdominal distension was 10 on postoperative day (POD) 1, increasing to 21 (45.65%) on POD 2 and 20 (42.48%) on POD 3, indicating a high natural incidence of distension without intervention. As shown in Table 2 and Figure 2, the incidence of abdominal distension and the incidence of severe abdominal distension both showed an upward trend within 1 to 3 days after the operation, which is consistent with the research results of Shi Yafei [25]. Notably, previous studies have predominantly focused on evaluating interventions at isolated time points. However, postoperative abdominal distension is a dynamic process, and the efficacy of interventions may vary over time. Therefore, continuous assessment and sustained intervention are crucial for accurately determining treatment effects. Furthermore, Table 4 demonstrates that only 5 (10.87%) patients in the control group had bowel movements by POD 3, indicating delayed intestinal motility and a high prevalence of constipation and gastrointestinal dysfunction. In contrast, the intervention group exhibited significantly improved bowel movement rates, underscoring the necessity of proactive distension management. The combination of TEAS and simethicone effectively alleviated postoperative abdominal distension, with earlier intervention demonstrating superior efficacy. As shown in Table 2, both the TEAS-simethicone and early combined intervention groups exhibited significantly lower overall and severe distension rates on postoperative days (POD) 2 and 3 compared to the control group ( P < 0.05). Table 3 further revealed that the early intervention group achieved faster symptom relief, showing advantages in both total and severe distension cases by POD 2, whereas the TEAS-simethicone group only demonstrated benefits by POD 3. TEAS effectively reduced distension incidence and severity, consistent with prior studies [26], by inducing muscle contractions and activating motor nerves to enhance gastrointestinal motility without thermal effects or surgical site interference [27-29]. In this study, electrodes placed on intestinal points and ST36 (Zusanli) delivered low-frequency (1-1,000 Hz) stimulation to create "physical propulsion," while simethicone acted as a surfactant to reduce gas accumulation via "chemical defoaming," establishing a synergistic dual-mechanism intervention. Furthermore, it is particularly important to note that in current clinical practice, the assessment of abdominal distension still faces the following challenges: insufficient standardization, methodological limitations, and difficulties in dynamic monitoring, etc. The 2023 American Gastroenterological Association guidelines recommend endoscopic evaluation only for patients with alarm features or abnormal physical findings [30]. Emerging tools like the 2022 Bloating Symptom Questionnaire by Lacy et al. [31] enable precise localization and quality-of-life impact quantification. Chinese researchers have proposed comprehensive assessments combining abdominal palpation, girth measurement [32], and intra-abdominal pressure monitoring [33]. This study enhanced traditional evaluation [22] by integrating criteria from Practical Integrated Chinese-Western Diagnosis and Therapy [20] and the Expert Consensus on Traditional Chinese Medicine Diagnosis/Treatment of Functional Bloating [21], incorporating girth measurement (≥2 cm increase predicting distension, OR=3.2, P <0.01 [34]), auscultation, and patient-reported outcomes. "Significant distension" was defined as ≥2 cm girth increase plus visual analog scale (VAS) ≥4 (sensitivity 78.3%, specificity 82.1%). Standardized assessment timing/position minimized circadian and dietary confounders. Future directions include validating international scales locally, identifying objective biomarkers, developing smart monitoring devices for dynamic evaluation, and applying AI for personalized assessment models to advance precision medicine in distension management [35]. Early TEAS combined with simethicone significantly accelerated postoperative gas passage and bowel movement. As shown in Tables 4 and 5, the first flatus time in the early TEAS-simethicone group (22.07±9.27 h) was significantly shorter than that in the control group (28.33±11.85 h, p<0.05), though no significant intergroup difference was observed in first defecation time. Tables 4 and 6 demonstrate superior bowel movement promotion in the early intervention group compared to controls ( P <0.0167), while the TEAS-simethicone group showed no statistically significant advantage in the proportion of patients achieving defecation. These findings highlight the critical role of intervention timing in enhancing early gastrointestinal recovery. This study provides two key clinical implications: (1) The window for abdominal distension management requires proactive advancement. Since postoperative abdominal distension typically becomes apparent only after postoperative day 1, delayed intervention until moderate/severe symptoms emerge may miss the optimal treatment window. (2) The operative day constitutes a pivotal timeframe for gastrointestinal function rehabilitation. Prolonged preoperative fasting, intraoperative anesthesia, prolonged bedrest, and fluid deficits collectively contribute to impaired intestinal motility that demands immediate intervention. TEAS operates through frequency-specific electrical pulses that resonate with intrinsic intestinal rhythms to enhance peristalsis. Recent evidence has expanded early electrical stimulation applications from critical care to postoperative settings, demonstrating that immediate postoperative TEAS improves functional status, muscle strength, and prevents ankle flexion contractures [36] - aligning perfectly with the concept of preoperative intestinal prehabilitation [37]. Clinicians should actively monitor postoperative gastrointestinal function and implement combined pharmacological-physical interventions during the early recovery phase, rather than awaiting symptom reporting. In this study, the combination of TEAS and simethicone failed to demonstrate significant efficacy in alleviating PONV, which contrasts with previous findings [38]. As shown in Table 4, no statistically significant differences in PONV incidence were observed among the three groups ( P > 0.05). This discrepancy may be attributed to three key factors: (1) Pharmacological interference: All patients received preoperative prophylactic ondansetron 16 mg orally disintegrating tablets, which likely contributed to the lower PONV incidence (below the reported 59.6% [41]) through its potent antiemetic effects [39,40]; (2) Mechanistic and acupoint selection differences: While PONV primarily involves neuroreflex pathways requiring stimulation of specific points (e.g., PC6) to modulate vagal and sympathetic activity, abdominal distension represents a more chronic pathological process responsive to gastrointestinal motility enhancement through Zusanli (ST36) stimulation; (3) Intervention targeting: The current TEAS protocol focused on intestinal points and ST36 for motility improvement rather than antiemetic central modulation. These findings suggest that a single TEAS-simethicone intervention cannot simultaneously address distinct symptom mechanisms, highlighting the need for future research to investigate optimized drug combinations and precise acupoint formulations (e.g., incorporating PC6) for comprehensive perioperative symptom management [42]. Limitations This study is a single-center study and only represents the results of the intervention for the research subjects with the same characteristics. However, this limitation precisely ensures the homogeneity of the sample and the specificity of the intervention measures. Secondly, the sample size of this study is relatively small. Future studies with a larger sample size can be conducted to further verify the results of this study. Finally, the intensity of electrical stimulation in this study was adjusted in real time according to the patient's condition, which also limits the generalizability of the study results. Conclusion This study demonstrated that TEAS combined with simethicone significantly alleviated postoperative abdominal distension in patients. Early implementation of this combined intervention not only effectively reduced distension but also promoted early flatus passage and bowel movement. Future research should focus on developing and validating more scientific assessment tools for abdominal distension, incorporating preoperative evaluations, establishing predictive models for postoperative distension in prostate cancer patients, extending follow-up durations to evaluate sustained efficacy, exploring dynamic monitoring methods and optimized interventions, and expanding the study population to enhance the generalizability of findings. These advancements will contribute to more comprehensive postoperative gastrointestinal management strategies. Abbreviations TEAS: Transcutaneous electrical acupoint stimulation; LRP: Laparoscopic radical prostatectomy; POI:postoperative ileus; ERAS: Enhanced Recovery After Surgery; POGD:postoperative gastrointestinal dysfunction; TCM: traditional Chinese medicine; PONV: postoperative nausea and vomiting; POD0: postoperative day 0; POD1: postoperative day 1; POD2: postoperative day 2; POD3: postoperative day 3. Declarations Acknowledgements All authors express their sincere gratitude to the Medical Records Department of Tongji Hospital for their assistance in data extraction, to all patients who participated in this study, and to the nursing staff for their meticulous implementation of the intervention protocols. Clinical trial number Not applicable. Authors' contributions QXQ: conceived and designed the study and wrote the initial draft of the manuscript. JL: conceived and designed the study and revised the first draft of the paper. DZ: contributed to manuscript text optimization and picture modification. HJW: collected and verified data. XQX: Collect and verify data. NLJ: Contribute to data retrieval and collation. LHH: Supervision, Methodology, Review & editing. FY: contributed to the study design, provided critical revisions for important intellectual content, and gave final approval of the version to be published. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding This study was supported by Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2024D38,2024D14,2024D18). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.Ethics approval and consent to participate. Availability of data and materials The dataset analyzed during the current study is available from the corresponding author on reasonable request. Ethics approval and consent to participate This study received approval from the Ethics Committee of Tongji Hospital, under review number TJ-IRB202502036 and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The requirement for written informed consent was waived by the ethics committee due to the retrospective nature of the study, which involved only anonymized data extracted from medical records without any additional interventions. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China References GBD C C. The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet (London, England), 2025, 406(10512): 1565-1586. https://doi.org/10.1016/S0140-6736(25)01635-6. Ploussard G. Robotic surgery in urology: facts and reality. What are the real advantages of robotic approaches for prostate cancer patients?[J]. Curr Opin Urol, 2018, 28(2): 153-158. https://doi.org/10.1097/MOU.0000000000000470. Ravi P, Choudhury A D. Defining Patient Benefits from High-intensity Intermittent Therapy for Hormone-sensitive Prostate Cancer[J]. European urology focus, 2023, 9(3): 419-421. https://doi.org/10.1016/j.euf.2023.01.004. Singh S, Bazarbashi A N, Khan A, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis[J]. Surgical endoscopy, 2022, 36(1): 252-266. https://doi.org/10.1007/s00464-020-08267-z. Qi Y, Liu Y, Liu X, et al. Identification of risk factors and clinical model construction of abdominal distension after radical cystectomy[J]. Transl Androl Urol, 2022, 11(12): 1629-1636. https://doi.org/10.21037/tau-22-455. Hruza M, Weiss H O, Pini G, et al. Complications in 2200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves[J]. Eur Urol, 2010, 58(5): 733-741. https://doi.org/10.1016/j.eururo.2010.08.024. Sugawara K, Kawaguchi Y, Nomura Y, et al. Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery[J]. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract, 2018, 22(3): 508-515. https://doi.org/10.1007/s11605-017-3622-8. Hedrick T L, McEvoy M D, Mythen M M G, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery[J]. Anesthesia and analgesia, 2018, 126(6): 1896-1907. https://doi.org/10.1213/ANE.0000000000002742. Wang Y, Wang L, Ni X, et al. Effect of acupuncture therapy for postoperative gastrointestinal dysfunction in gastric and colorectal cancers: an umbrella review[J]. Frontiers in oncology, 2024, 14: 1291524. https://doi.org/10.3389/fonc.2024.1291524. Ge Z, Chen H, Gao Y, et al. The role of simeticone in small-bowel preparation for capsule endoscopy[J]. Endoscopy, 2006, 38(8): 836-840. https://doi.org/10.1055/s-2006-944634. Chen L J, Hong L L, Wang H L. Clinical observation of simethicone in the treatment of abdominal distension in liver cancer patients[J]. Modern Oncology, 2010, 18(09): 1842-1843. https://doi.org/10.3969/j.issn.1672-4992. Zhu Y, Li J, Gao J, et al. Effect of simethicone for the management of early abdominal distension after laparoscopic cholecystectomy: a multicenter retrospective propensity score matching study[J]. BMC surgery, 2024, 24(1): 170. https://doi.org/10.1186/s12893-024-02460-w. Li C, Liu K X, Deng X M, et al. Expert consensus on prevention and treatment of postoperative gastrointestinal dysfunction[J]. International Journal of Anesthesiology and Resuscitation, 2021, 42(11): 1133-1142. https://doi.org/10.3760/cma.j.cn321761-20210811-10003. Expert consensus on the application of electrophysiological technology in perioperative accelerated rehabilitation of andrology[J]. Chinese Journal of Andrology, 2025, 31(03): 258-266. https://doi.org/10.13263/j.cnki.nja.2025.03.011. Li W, Gao C, An L, et al. Perioperative transcutaneous electrical acupoint stimulation for improving postoperative gastrointestinal function: A randomized controlled trial[J]. J Integr Med, 2021, 19(3): 211-218. https://doi.org/10.1016/j.joim.2021.01.005. Karthik N, Lodha M, Baksi A, et al. Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: A randomized controlled trial[J]. World J Surg, 2024, 48(7): 1626-1633. https://doi.org/10.1002/wjs.12233. Li Q, Larissa T, Liu H, et al. Effectiveness of an immediate postoperative electroacupuncture session for the recovery of gastrointestinal function after laparoscopic cholecystectomy: a randomized controlled trial[J]. Acupunct Med, 2025, 43(3): 127-136. https://doi.org/10.1177/09645284251343914. Zhang Y M, Feng X Q, Zhao T Y, et al. Construction and application of a whole-process nursing management scheme for daytime surgery in patients undergoing radical prostatectomy[J]. Chinese Nursing Management, 2024, 24(02): 293-299. https://doi.org/10.3969/j.issn.1672-1756.2024.02.025. Chinese Society of Clinical Oncology Guidelines Working Committee, Zhong G, et al. Chinese Society of Clinical Oncology (CSCO) Prostate Cancer Diagnosis and Treatment Guidelines 2023[M].2023. https://lib.hust.edu.cn/asset/detail/1011192261448. Zhang J H, Guo J R, Zhou Y Z. Practical Integrated Traditional Chinese and Western Medicine Diagnosis and Therapeutics[M]. 2019. https://lib.hust.edu.cn/asset/detail/20165200220. Spleen and Stomach Diseases Branch of Chinese Association of Traditional Chinese Medicine. Expert consensus on traditional Chinese medicine diagnosis and treatment of functional abdominal distension (2023)[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion, 2024, 32(07): 549-555. https://doi.org/10.3969/j.issn.1671-038X.2024.07.01. National Medical Products Administration Center for Drug Evaluation. Notice on the release of "Technical Guidelines for Clinical Research of New Traditional Chinese Medicines for Chronic Constipation" and "Technical Guidelines for Clinical Research of New Traditional Chinese Medicines for Diabetic Kidney Disease"[Z]. 2020.https://lib.hust.edu.cn/asset/detail/20868389419. Gan T J, Belani K G, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2020, 131(2): 411-448. https://doi.org/10.1213/ANE.0000000000004833. Hori T, Makino T, Fujimura R, et al. Favorable Impact on Postoperative Abdominal Symptoms in Robot-assisted Radical Prostatectomy Using Enhanced Recovery After Surgery Protocol[J]. Cancer Diagn Progn, 2022, 2(2): 247-252. https://doi.org/10.21873/cdp.10101. Shi Y F. Clinical study on umbilical moxibustion combined with transcutaneous electrical acupoint stimulation for prevention and treatment of abdominal distension after total hip arthroplasty[D]. Shandong University of Traditional Chinese Medicine, 2023. https://doi.org/10.27282/d.cnki.gsdzu.2023.000460. Huang X, Gu H, Shen P, et al. Meta-analysis of electrical stimulation promoting recovery of gastrointestinal function after gynecological abdominal surgery[J]. World J Gastrointest Surg, 2024, 16(11): 3559-3567. https://doi.org/10.4240/wjgs.v16.i11.3559. Lu L M, Tian X. Effect of transcutaneous electrical acupoint stimulation on enteral nutrition in ICU patients with severe brain injury[J]. Shanghai Journal of Acupuncture and Moxibustion, 2022, 41(08): 786-789. https://doi.org/10.13460/j.issn.1005-0957.2022.08.0786. Li H, Du C, Lu L, et al. Transcutaneous electrical acupoint stimulation combined with electroacupuncture promotes rapid recovery after abdominal surgery: Study protocol for a randomized controlled trial[J]. Front Public Health, 2022, 10: 1017375. https://doi.org/10.3389/fpubh.2022.1017375. Yang N, Ye Y, Tian Z, et al. Effects of electroacupuncture on the intestinal motility and local inflammation are modulated by acupoint selection and stimulation frequency in postoperative ileus mice[J]. Neurogastroenterol Motil, 2020, 32(5): e13808. https://doi.org/10.1111/nmo.13808. Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review[J]. Gastroenterology, 2023, 165(3): 791-800. https://doi.org/10.1053/j.gastro.2023.04.039. Lacy B E, Cangemi D J, Wise J L, et al. Development and validation of a novel scoring system for bloating and distension: The Mayo Bloating Questionnaire[J]. Neurogastroenterol Motil, 2022, 34(8): e14330. https://doi.org/10.1111/nmo.14330. Mi Y Y, Huang P P, Wu B N, et al. Summary of best evidence for prevention and management of enteral nutrition-related abdominal distension in ICU patients[J]. Journal of Nursing Science, 2022, 37(02): 91-95. https://doi.org/10.3870/j.issn.1001-4152.2022.02.091. Ni X M, Hu S H, Han J Y, et al. Application of nurse-led bedside ultrasound in the management of abdominal distension in ICU patients receiving enteral nutrition[J]. Chinese Journal of Nursing, 2024, 59(17): 2123-2129. https://doi.org/10.3761/j.issn.0254-1769.2024.17.011. Drossman D A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV[J]. Gastroenterology, 2016. https://doi.org/10.1053/j.gastro.2016.02.032. Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review[J]. Gastroenterology, 2023, 165(3): 791-800. https://doi.org/10.1053/j.gastro.2023.04.039. Campos D R, Bueno T B C, Anjos J S G G, et al. Early Neuromuscular Electrical Stimulation in Addition to Early Mobilization Improves Functional Status and Decreases Hospitalization Days of Critically Ill Patients[J]. Crit Care Med, 2022, 50(7): 1116-1126. https://doi.org/10.1097/CCM.0000000000005557. Wu J, Chi H, Kok S, et al. Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery[J]. Ann Coloproctol, 2024, 40(1): 3-12. https://doi.org/10.3393/ac.2022.01207.0172. Szmit M, Krajewski R, Rudnicki J, et al. Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review[J]. Adv Clin Exp Med, 2023, 32(9): 1063-1074. https://doi.org/10.17219/acem/159703. Chen X, Zhang Y X, Zhou H Y, et al. Summary of best evidence for non-pharmacological management of postoperative nausea and vomiting[J]. Chinese Journal of Nursing, 2021, 56(11): 1721-1727. https://doi.org/10.3761/j.issn.0254-1769.2021.11.021. Zhang L, Song K C, Shen L. Multimodal postoperative nausea and vomiting management strategy driven by the concept of enhanced recovery after surgery: Interpretation of "Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting"[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(04): 490-495. https://doi.org/10.12290/xhyxzz.2021-0189. Yuan L, Quan S, Li X, et al. Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after laparoscopic surgery: A meta-analysis[J]. J Nurs Scholarsh, 2025, 57(3): 371-379. https://doi.org/10.1111/jnu.13033. Szmit M, Krajewski R, Rudnicki J, et al. Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review[J]. Advances in clinical and experimental medicine: official organ Wroclaw Medical University, 2023, 32(9): 1063-1074. https://doi.org/10.17219/acem/159703. Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Figures1to4.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 18 Mar, 2026 Editor invited by journal 17 Feb, 2026 Editor assigned by journal 23 Jan, 2026 Submission checks completed at journal 23 Jan, 2026 First submitted to journal 22 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8669687","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":610102397,"identity":"24f78892-6af3-4035-ae6e-f36b42296d5c","order_by":0,"name":"qiuxia qin","email":"","orcid":"","institution":"Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"qiuxia","middleName":"","lastName":"qin","suffix":""},{"id":610102403,"identity":"68ab356e-7959-4a15-9c64-280dd6802194","order_by":1,"name":"Juan liu","email":"","orcid":"","institution":"Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"liu","suffix":""},{"id":610102405,"identity":"348aa3c7-78fd-4f03-946e-f874d0baecd8","order_by":2,"name":"duo zhang","email":"","orcid":"","institution":"Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"duo","middleName":"","lastName":"zhang","suffix":""},{"id":610102406,"identity":"62418312-ed1a-4266-a4b3-6d757b2ca891","order_by":3,"name":"hongjiao wang","email":"","orcid":"","institution":"Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"hongjiao","middleName":"","lastName":"wang","suffix":""},{"id":610102407,"identity":"be6ac855-d001-4a96-9e0e-4235548c1200","order_by":4,"name":"xiaoqin xie","email":"","orcid":"","institution":"Tongji 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figure legend\u003c/p\u003e","description":"","filename":"export2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8669687/v1/4b3b114d900dd822be6a9fef.jpg"},{"id":105569329,"identity":"e3dfec26-9984-46fc-a7b6-40fc3d216a77","added_by":"auto","created_at":"2026-03-27 13:12:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":994184,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8669687/v1/f4efbd0c-63f8-4bd6-8571-0a4f78acfc86.pdf"},{"id":105565209,"identity":"0b3216f2-924e-44e8-aec5-dc590980ebd0","added_by":"auto","created_at":"2026-03-27 12:52:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20065,"visible":true,"origin":"","legend":"","description":"","filename":"Figures1to4.docx","url":"https://assets-eu.researchsquare.com/files/rs-8669687/v1/f1fce9109d8df7cc4fff9621.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early TEAS Combined with Simethicone for Accelerated Gastrointestinal Recovery after Prostate Cancer Surgery: A case-control study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer is the second most common malignancy in men, with a rising global incidence [1]. Laparoscopic radical prostatectomy (LRP) under general anesthesia has become the gold standard for treating localized prostate cancer [2]. Post-laparoscopic abdominal distension occurs in 15\u0026ndash;30% of cases, with 3\u0026ndash;8% progressing to severe complications such as postoperative ileus (POI) requiring intervention [3,4]. Abdominal distension exacerbates incisional pain, delays wound healing, impairs sleep quality, and may lead to prolonged recovery and hospitalization, imposing significant physical and psychological burdens on patients [5]. Given the proximity of prostatectomy incisions to the abdominal and pelvic regions, distension is a critical factor affecting wound healing and postoperative pain. Recent guidelines classify post-prostatectomy abdominal distension as a Grade 2 complication, highlighting its importance in Enhanced Recovery After Surgery protocols [6].\u003c/p\u003e\n\u003cp\u003eThe etiology of post-laparoscopic distension is multifactorial, involving surgical factors, patient-related variables, and postoperative management [7]. Historically, postoperative gastrointestinal dysfunction (POGD) was considered inevitable, but emerging evidence suggests it is modifiable [8]. Current interventions include pharmacological and physical therapies [9]. Simethicone, a stable surfactant approved by the FDA in 1952 [10], is widely used in gastroscopy. A 2010 single-center pilot study demonstrated its efficacy in alleviating post-laparoscopic distension [11], though its mechanism and broader applicability remain under investigation.In 2024, a multicenter clinical trial involving 1,520 participants confirmed that simethicone was an independent predictor of bloating relief after laparoscopic cholecystectomy (OR = 1.89, P \u0026lt; 0.001). In this study, all patients received oral simethicone at six hours postoperatively, further validating the efficacy and safety of early postoperative administration [12]. However, the study did not explore different timing intervals for intervention, leaving it unclear whether earlier versus later administration of simethicone would yield different effects on bloating.\u003c/p\u003e\n\u003cp\u003eThe 2021 Expert Consensus on POGD Management strongly endorsed traditional Chinese medicine (TCM) therapies, including acupuncture, acupressure, and electroacupuncture [13]. TEAS integrating TCM theory with modern electrotherapy, delivers pulsed currents via cutaneous electrodes [14]. Preliminary studies support its role in accelerating postoperative gastrointestinal recovery [15]. With advancements in ERAS protocols, early TEAS has gained attention for its potential to enhance recovery. Evidence suggests that TEAS administered within 24 hours post-cesarean section or immediately after laparoscopic cholecystectomy promotes faster gut motility restoration [16,17]. As hospital stays for prostatectomy patients shorten and same-day surgeries increase, optimizing early interventions is crucial for resource utilization and patient-centered care [18].\u003c/p\u003e\n\u003cp\u003eIn summary, while simethicone and TEAS have demonstrated individual efficacy in postoperative recovery, data on optimal timing and combined interventions remain scarce. Most studies rely on static, single-timepoint assessments of distension severity, limiting clinical applicability. Given the dynamic nature of postoperative distension, this retrospective cohort study compares conventional care, simethicone + TEAS, and early simethicone + TEAS to establish evidence-based guidelines for postoperative abdominal distension management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study analyzed medical records of prostate cancer patients who underwent laparoscopic radical prostatectomy at Tongji Hospital, Wuhan, China between February and November 2025. All cases were performed by the same surgical team. Patients were divided into three groups based on postoperative orders: (1) Control group (no simethicone or transcutaneous electrical acupoint stimulation [TEAS] prescribed); (2) TEAS+simethicone group (both interventions initiated on postoperative day 1); and (3) Early TEAS+simethicone group (interventions administered on the operative day). Inclusion Criteria: Eligible patients met all following criteria: (1) Complete medical documentation including present illness history (demographics, medication history, diagnostic process), past medical history (GI disorders), anesthesia records (operative time, surgical approach, analgesic pump usage), temperature charts (bowel movements), physician orders (simethicone/TEAS administration timing/frequency, enema use), nursing records (TEAS implementation), and ERAS compliance forms (abdominal distension, nausea/vomiting, flatus); (2) Confirmed prostate cancer diagnosis[19]; (3) Underwent laparoscopic radical prostatectomy during hospitalization; (4) Received daily TEAS with ≥6 total sessions.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria: Patients were excluded for: (1) Pelvic floor dysfunction (documented in medical history); (2) Pre-existing GI motility disorders; (3) Use of other intestinal motility-modulating drugs within 1 month preoperatively or during hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size calculation: Utilizing G-power software for a three-group ANOVA sample size estimation, with an effect size f = 0.25, α = 0.05, and Power = 0.8, the minimum required sample size was determined to be 135, with at least 45 subjects per group. A preliminary screening identified 142 medical records, of which 4 were excluded based on inclusion and exclusion criteria (2 due to incomplete data, 2 owing to electrical stimulation administered for fewer than 3 days). The final valid sample comprised 46 subjects per group, resulting in a total of 138 cases.This study was approved by the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (TJ-IRB202502036).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to medical record extraction, a survey was conducted with two prescribing physicians, which revealed that the issuance of medical orders was influenced by both the availability of sufficient time for order placement and individual practice patterns. Specifically, one physician routinely prescribed both electrical stimulation and simethicone, while the other did not. Based on whether the medical orders included simethicone and electrical stimulation as required, three distinct intervention protocols were established, with nurses implementing the corresponding measures according to the physician orders.\u003c/p\u003e\n\u003cp\u003eThe control group received standard care, which included: (1) Room temperature adjustment to 22–26°C; (2) Dietary and activity guidance: On postoperative day 1, the assigned nurse assisted patients in ambulation and provided standardized education on diet and fluid intake daily; (3) Psychological support: Assessment of abdominal distention severity, explanation of its potential duration, and alleviation of patient anxiety. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Transcutaneous Electrical Acupoint Stimulation (TEAS) combined with simethicone group received additional interventions beyond the standard care: (1) TEAS equipment: A low-frequency neuromuscular stimulator (model: Biostim base; registration no.: Guangdong Medical Device Approval 20182260716; manufacturer: Foshan Shanshan Datang Medical Technology Co., Ltd.). Indications: Promotion of local blood circulation, pain relief, and neuromuscular excitation. (2) TEAS electrode placement and parameters: One pair of electrodes applied to the Zusanli (ST36) acupoint on the leg (frequency: 20–30 Hz, pulse width: 300–500 μs); another pair placed over the transverse and descending colon, maintaining a distance \u0026gt;2 cm from the surgical incision (frequency: 20–30 Hz, pulse width: 300 μs, current intensity adjusted to patient comfort without pain) [14]. (3) TEAS intervention schedule: Initiated on postoperative day 1, administered twice daily for 3 consecutive days (total 6 sessions), each session lasting 30 minutes [14]. (4) Simethicone administration: Patients were instructed to initiate oral simethicone (3 mL three times daily) starting on postoperative day 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe early TEAS combined with simethicone group received accelerated interventions: (1) TEAS parameters and electrode placement identical to the TEAS+simethicone group; (2) TEAS timing: One session administered on the day of surgery, followed by twice-daily sessions for 3 consecutive days (total 7 sessions), as per medical orders; (3) Simethicone regimen: Initial dose (3 mL) administered 6 hours postoperatively, followed by 3 mL three times daily (total 10 doses). The study design flowchart is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation Methods for Gastrointestinal Function Recovery Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study assessed gastrointestinal recovery using three parameters (abdominal distension, time to first flatus, and defecation within 3 postoperative days) recorded in the Enhanced Recovery After Surgery (ERAS) checklist. While first flatus and defecation were objective outcomes documented by nurses through patient interviews, no standardized objective measure exists for postoperative distension. We therefore developed an evidence-based assessment protocol through literature review, two expert panel meetings, and pilot testing. According to Practical Diagnosis and Therapy in Integrated Traditional Chinese and Western Medicine [20], comprehensive evaluation incorporated six dimensions: distension, abdominal pain, palpation, bowel sounds, flatus, and defecation. Distension severity was determined through dual clinician-patient assessment [21], categorized into four grades per China's Clinical Research Guidelines for New Chinese Medicine Drugs [22] based on symptom reports and umbilical circumference measurements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbdominal Distension Assessment Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical Examination: A standardized evaluation was performed, beginning with patient-reported symptoms, followed by systematic examination: inspection (abdominal distension and diaphragmatic breathing), auscultation (bowel sounds), superficial palpation (1–2 cm depth at supra-/infra-umbilical regions, avoiding wounds), percussion, and measurement of baseline/daily umbilical circumference.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(2) Assessment Method: Daily evaluations (8:30–9:00 AM) were conducted with patients in the supine position, integrating findings from inspection, auscultation, palpation, percussion, and measurements with patient reports to assign distension grades.\u003c/p\u003e\n\u003cp\u003e(3) Result Adjudication: Two geriatric-trained nurses independently graded distension; discrepancies were resolved by the attending physician.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistension Grading Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) None: No discomfort; no functional impact; stable abdominal girth.\u003c/p\u003e\n\u003cp\u003e(2) Mild: Slight tenderness on palpation; flat abdomen; preserved diaphragmatic breathing; minor sleep/activity interference.\u003c/p\u003e\n\u003cp\u003e(3) Moderate: Mild tenderness; palpable bloating; reduced diaphragmatic breathing; significant functional impairment.\u003c/p\u003e\n\u003cp\u003e(4) Severe: Marked tenderness; pronounced distension; absent/diminished diaphragmatic breathing; profound functional limitation; ≥2 cm girth increase.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePONV Assessment Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNausea and vomiting were evaluated according to the World Health Organization (WHO) grading criteria [23]:\u003c/p\u003e\n\u003cp\u003eGrade 0: No nausea or vomiting.\u003c/p\u003e\n\u003cp\u003eGrade 1: Mild nausea or abdominal discomfort without vomiting.\u003c/p\u003e\n\u003cp\u003eGrade 2: Transient vomiting (≤1 episode).\u003c/p\u003e\n\u003cp\u003eGrade 3: Vomiting requiring antiemetic medication (≤2 episodes).\u003c/p\u003e\n\u003cp\u003eGrade 4: Intractable vomiting (≥3 episodes) unresponsive to medication.\u003c/p\u003e\n\u003cp\u003eNurses regularly assessed patients' symptoms and recorded the frequency of vomiting during the first 3 postoperative days on the ERAS checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Control Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure data reliability, all study data were collected from a single department and ward to minimize confounding factors. Two specialized nurses, blinded to the patients' intervention groups, were responsible for data collection. Prior to the study, they underwent standardized training and assessment on abdominal distension evaluation, achieving an inter-rater reliability (Cohen's Kappa coefficient) of 0.81. Additionally, two independent staff members performed dual data entry and automated validation checks to prevent human errors in data recording.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 25.0 software. Normally distributed continuous data were presented as frequencies and percentages, with one-way ANOVA used for comparing means among three groups. Categorical variables were analyzed using chi-square tests, and multiple comparisons were adjusted with Bonferroni correction. The significance level was set at α = 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring this study, a total of 142 medical records were collected. Based on the predefined inclusion and exclusion criteria, 4 records were excluded from the final analysis. A total of 4 cases were excluded: 2 due to incomplete medical records, 2 with pre-existing gastric conditions. These exclusions were deemed non-influential based on: (1) Baseline equivalence: No differences in age/sex between excluded and included cases (all p\u0026gt;0.05) (2) Weight assessment: Exclusions represented only 2.8% (4/142) of eligible cases (5% threshold). The study recorded no adverse events associated with either simethicone administration or electrical stimulation interventions. Final analysis included 46 complete medical records per study group, with all three groups demonstrating balanced baseline characteristics (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Multiple comparisons of time to first flatus among three groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003eMean difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003eStandard error\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e95% \u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e3.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e-0.771\u003cem\u003e～\u003c/em\u003e8.640\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.271\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e1.566\u003cem\u003e～\u003c/em\u003e10.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e-3.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e-8.640\u003cem\u003e～\u003c/em\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e2.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e-2.368\u003cem\u003e～\u003c/em\u003e7.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003eGroup 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-6.271\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e-10.977\u003cem\u003e～\u003c/em\u003e-1.566\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1292%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2546%;\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7122%;\"\u003e\n \u003cp\u003e-2.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5277%;\"\u003e\n \u003cp\u003e2.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.2362%;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1402%;\"\u003e\n \u003cp\u003e-7.042\u003cem\u003e～\u003c/em\u003e2.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote.\u0026nbsp;*=\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0167. Group 1: Control group; Group 2: TEAS combined with simethicone group; Group 3: Early TEAS combined with simethicone group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Multiple comparisons of Defecation among three groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"551\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.0236%;\"\u003e\n \u003cp\u003eComparison groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33.9383%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u0026sup2;\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.0381%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.0236%;\"\u003e\n \u003cp\u003eGroup 1 vs Group 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.9383%;\"\u003e\n \u003cp\u003e7.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.0381%;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.0236%;\"\u003e\n \u003cp\u003eGroup 2 vs Group 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.9383%;\"\u003e\n \u003cp\u003e8.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.0381%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.0236%;\"\u003e\n \u003cp\u003eGroup 1 vs Group 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.9383%;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.0381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote.\u0026nbsp;*=\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0167. Group 1: Control group; Group 2: TEAS combined with simethicone group; Group 3: Early TEAS combined with simethicone group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePostoperative abdominal distension significantly impairs recovery in prostate cancer patients, with its incidence influenced by multiple factors including age, surgical approach, medication, activity level, and diet [24]. Older age and prolonged operative duration are associated with a higher incidence of abdominal distension. This study demonstrated that TEAS combined with simethicone effectively alleviated abdominal distension and accelerated bowel movement resumption. Early intervention with TEAS and simethicone not only promoted faster defecation but also showed superior efficacy in reducing abdominal distension and facilitating early flatus. No adverse effects related to electrical stimulation or medication were reported, confirming the safety and efficacy of early postoperative TEAS combined with simethicone administration. The findings provide both theoretical and practical insights for postoperative gastrointestinal dysfunction management. Theoretically, this study elucidates the temporal pattern of postoperative distension and the benefits of early intervention, enhancing our understanding of the surgical stress response following laparoscopy and contributing critical parameters for predictive models of gastrointestinal recovery. Practically, the combined physical (TEAS) and pharmacological (simethicone) approach demonstrated significant efficacy in accelerating postoperative gastrointestinal function recovery. Given its favorable safety profile and patient tolerance, this strategy holds substantial clinical and economic value by optimizing healthcare resource utilization and reducing hospital stays.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; The present study revealed a high incidence and prolonged duration of postoperative abdominal distension in prostate cancer patients, exhibiting a distinct temporal pattern. In the control group, the number of patients experiencing abdominal distension was 10 on postoperative day (POD) 1, increasing to 21 (45.65%) on POD 2 and 20 (42.48%) on POD 3, indicating a high natural incidence of distension without intervention. As shown in Table 2 and Figure 2, the incidence of abdominal distension and the incidence of severe abdominal distension both showed an upward trend within 1 to 3 days after the operation, which is consistent with the research results of Shi Yafei [25]. Notably, previous studies have predominantly focused on evaluating interventions at isolated time points. However, postoperative abdominal distension is a dynamic process, and the efficacy of interventions may vary over time. Therefore, continuous assessment and sustained intervention are crucial for accurately determining treatment effects. Furthermore, Table 4 demonstrates that only 5 (10.87%) patients in the control group had bowel movements by POD 3, indicating delayed intestinal motility and a high prevalence of constipation and gastrointestinal dysfunction. In contrast, the intervention group exhibited significantly improved bowel movement rates, underscoring the necessity of proactive distension management.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; The combination of TEAS and simethicone effectively alleviated postoperative abdominal distension, with earlier intervention demonstrating superior efficacy. As shown in Table 2, both the TEAS-simethicone and early combined intervention groups exhibited significantly lower overall and severe distension rates on postoperative days (POD) 2 and 3 compared to the control group (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). Table 3 further revealed that the early intervention group achieved faster symptom relief, showing advantages in both total and severe distension cases by POD 2, whereas the TEAS-simethicone group only demonstrated benefits by POD 3. TEAS effectively reduced distension incidence and severity, consistent with prior studies [26], by inducing muscle contractions and activating motor nerves to enhance gastrointestinal motility without thermal effects or surgical site interference [27-29]. In this study, electrodes placed on intestinal points and ST36 (Zusanli) delivered low-frequency (1-1,000 Hz) stimulation to create \"physical propulsion,\" while simethicone acted as a surfactant to reduce gas accumulation via \"chemical defoaming,\" establishing a synergistic dual-mechanism intervention. Furthermore, it is particularly important to note that in current clinical practice, the assessment of abdominal distension still faces the following challenges: insufficient standardization, methodological limitations, and difficulties in dynamic monitoring, etc. The 2023 American Gastroenterological Association guidelines recommend endoscopic evaluation only for patients with alarm features or abnormal physical findings [30]. Emerging tools like the 2022 Bloating Symptom Questionnaire by Lacy et al. [31] enable precise localization and quality-of-life impact quantification. Chinese researchers have proposed comprehensive assessments combining abdominal palpation, girth measurement [32], and intra-abdominal pressure monitoring [33]. This study enhanced traditional evaluation [22] by integrating criteria from Practical Integrated Chinese-Western Diagnosis and Therapy [20] and the Expert Consensus on Traditional Chinese Medicine Diagnosis/Treatment of Functional Bloating [21], incorporating girth measurement (≥2 cm increase predicting distension, OR=3.2, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01 [34]), auscultation, and patient-reported outcomes. \"Significant distension\" was defined as\u0026nbsp;≥2 cm girth increase plus visual analog scale (VAS)\u0026nbsp;≥4 (sensitivity 78.3%, specificity 82.1%). Standardized assessment timing/position minimized circadian and dietary confounders. Future directions include validating international scales locally, identifying objective biomarkers, developing smart monitoring devices for dynamic evaluation, and applying AI for personalized assessment models to advance precision medicine in distension management [35].\u003c/p\u003e\n\u003cp\u003eEarly TEAS combined with simethicone significantly accelerated postoperative gas passage and bowel movement. As shown in Tables 4 and 5, the first flatus time in the early TEAS-simethicone group (22.07±9.27 h) was significantly shorter than that in the control group (28.33±11.85 h, p\u0026lt;0.05), though no significant intergroup difference was observed in first defecation time. Tables 4 and 6 demonstrate superior bowel movement promotion in the early intervention group compared to controls (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.0167), while the TEAS-simethicone group showed no statistically significant advantage in the proportion of patients achieving defecation. These findings highlight the critical role of intervention timing in enhancing early gastrointestinal recovery. This study provides two key clinical implications: (1) The window for abdominal distension management requires proactive advancement. Since postoperative abdominal distension typically becomes apparent only after postoperative day 1, delayed intervention until moderate/severe symptoms emerge may miss the optimal treatment window. (2) The operative day constitutes a pivotal timeframe for gastrointestinal function rehabilitation. Prolonged preoperative fasting, intraoperative anesthesia, prolonged bedrest, and fluid deficits collectively contribute to impaired intestinal motility that demands immediate intervention. TEAS operates through frequency-specific electrical pulses that resonate with intrinsic intestinal rhythms to enhance peristalsis. Recent evidence has expanded early electrical stimulation applications from critical care to postoperative settings, demonstrating that immediate postoperative TEAS improves functional status, muscle strength, and prevents ankle flexion contractures [36] - aligning perfectly with the concept of preoperative intestinal prehabilitation [37]. Clinicians should actively monitor postoperative gastrointestinal function and implement combined pharmacological-physical interventions during the early recovery phase, rather than awaiting symptom reporting.\u003c/p\u003e\n\u003cp\u003eIn this study, the combination of TEAS and simethicone failed to demonstrate significant efficacy in alleviating PONV, which contrasts with previous findings [38]. As shown in Table 4, no statistically significant differences in PONV incidence were observed among the three groups (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). This discrepancy may be attributed to three key factors: (1) Pharmacological interference: All patients received preoperative prophylactic ondansetron 16 mg orally disintegrating tablets, which likely contributed to the lower PONV incidence (below the reported 59.6% [41]) through its potent antiemetic effects [39,40]; (2) Mechanistic and acupoint selection differences: While PONV primarily involves neuroreflex pathways requiring stimulation of specific points (e.g., PC6) to modulate vagal and sympathetic activity, abdominal distension represents a more chronic pathological process responsive to gastrointestinal motility enhancement through Zusanli (ST36) stimulation; (3) Intervention targeting: The current TEAS protocol focused on intestinal points and ST36 for motility improvement rather than antiemetic central modulation. These findings suggest that a single TEAS-simethicone intervention cannot simultaneously address distinct symptom mechanisms, highlighting the need for future research to investigate optimized drug combinations and precise acupoint formulations (e.g., incorporating PC6) for comprehensive perioperative symptom management [42].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a single-center study and only represents the results of the intervention for the research subjects with the same characteristics. However, this limitation precisely ensures the homogeneity of the sample and the specificity of the intervention measures. Secondly, the sample size of this study is relatively small. Future studies with a larger sample size can be conducted to further verify the results of this study. Finally, the intensity of electrical stimulation in this study was adjusted in real time according to the patient's condition, which also limits the generalizability of the study results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that TEAS combined with simethicone significantly alleviated postoperative abdominal distension in patients. Early implementation of this combined intervention not only effectively reduced distension but also promoted early flatus passage and bowel movement. Future research should focus on developing and validating more scientific assessment tools for abdominal distension, incorporating preoperative evaluations, establishing predictive models for postoperative distension in prostate cancer patients, extending follow-up durations to evaluate sustained efficacy, exploring dynamic monitoring methods and optimized interventions, and expanding the study population to enhance the generalizability of findings. These advancements will contribute to more comprehensive postoperative gastrointestinal management strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTEAS: Transcutaneous electrical acupoint stimulation; LRP: Laparoscopic radical prostatectomy; POI:postoperative ileus; ERAS: Enhanced Recovery After Surgery; POGD:postoperative gastrointestinal dysfunction; TCM: traditional Chinese medicine; PONV: postoperative nausea and vomiting; POD0: postoperative day 0; POD1: postoperative day 1; POD2: postoperative day 2; POD3: postoperative day 3.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors express their sincere gratitude to the Medical Records Department of Tongji Hospital for their assistance in data extraction, to all patients who participated in this study, and to the nursing staff for their meticulous implementation of the intervention protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQXQ: conceived and designed the study and wrote the initial draft of the manuscript. JL: conceived and designed the study and revised the first draft of the paper. DZ: contributed to manuscript text optimization and picture modification. HJW: collected and verified data. XQX: Collect and verify data. NLJ: Contribute to data retrieval and collation. LHH: Supervision, Methodology, Review \u0026amp; editing. FY: contributed to the study design, provided critical revisions for important intellectual content, and gave final approval of the version to be published. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2024D38,2024D14,2024D18). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.Ethics approval and consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Ethics Committee of Tongji Hospital, under review number TJ-IRB202502036 and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The requirement for written informed consent was waived by the ethics committee due to the retrospective nature of the study, which involved only anonymized data extracted from medical records without any additional interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGBD C C. The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet (London, England), 2025, 406(10512): 1565-1586. https://doi.org/10.1016/S0140-6736(25)01635-6.\u003c/li\u003e\n\u003cli\u003ePloussard G. Robotic surgery in urology: facts and reality. What are the real advantages of robotic approaches for prostate cancer patients?[J]. Curr Opin Urol, 2018, 28(2): 153-158. https://doi.org/10.1097/MOU.0000000000000470.\u003c/li\u003e\n\u003cli\u003eRavi P, Choudhury A D. Defining Patient Benefits from High-intensity Intermittent Therapy for Hormone-sensitive Prostate Cancer[J]. European urology focus, 2023, 9(3): 419-421. https://doi.org/10.1016/j.euf.2023.01.004.\u003c/li\u003e\n\u003cli\u003eSingh S, Bazarbashi A N, Khan A, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis[J]. Surgical endoscopy, 2022, 36(1): 252-266. https://doi.org/10.1007/s00464-020-08267-z.\u003c/li\u003e\n\u003cli\u003eQi Y, Liu Y, Liu X, et al. Identification of risk factors and clinical model construction of abdominal distension after radical cystectomy[J]. Transl Androl Urol, 2022, 11(12): 1629-1636. https://doi.org/10.21037/tau-22-455.\u003c/li\u003e\n\u003cli\u003eHruza M, Weiss H O, Pini G, et al. Complications in 2200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves[J]. Eur Urol, 2010, 58(5): 733-741. https://doi.org/10.1016/j.eururo.2010.08.024.\u003c/li\u003e\n\u003cli\u003eSugawara K, Kawaguchi Y, Nomura Y, et al. Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery[J]. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract, 2018, 22(3): 508-515. https://doi.org/10.1007/s11605-017-3622-8.\u003c/li\u003e\n\u003cli\u003eHedrick T L, McEvoy M D, Mythen M M G, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery[J]. Anesthesia and analgesia, 2018, 126(6): 1896-1907. https://doi.org/10.1213/ANE.0000000000002742.\u003c/li\u003e\n\u003cli\u003eWang Y, Wang L, Ni X, et al. Effect of acupuncture therapy for postoperative gastrointestinal dysfunction in gastric and colorectal cancers: an umbrella review[J]. Frontiers in oncology, 2024, 14: 1291524. https://doi.org/10.3389/fonc.2024.1291524.\u003c/li\u003e\n\u003cli\u003eGe Z, Chen H, Gao Y, et al. The role of simeticone in small-bowel preparation for capsule endoscopy[J]. Endoscopy, 2006, 38(8): 836-840. https://doi.org/10.1055/s-2006-944634.\u003c/li\u003e\n\u003cli\u003eChen L J, Hong L L, Wang H L. Clinical observation of simethicone in the treatment of abdominal distension in liver cancer patients[J]. Modern Oncology, 2010, 18(09): 1842-1843. https://doi.org/10.3969/j.issn.1672-4992.\u003c/li\u003e\n\u003cli\u003eZhu Y, Li J, Gao J, et al. Effect of simethicone for the management of early abdominal distension after laparoscopic cholecystectomy: a multicenter retrospective propensity score matching study[J]. BMC surgery, 2024, 24(1): 170. https://doi.org/10.1186/s12893-024-02460-w.\u003c/li\u003e\n\u003cli\u003eLi C, Liu K X, Deng X M, et al. Expert consensus on prevention and treatment of postoperative gastrointestinal dysfunction[J]. International Journal of Anesthesiology and Resuscitation, 2021, 42(11): 1133-1142. https://doi.org/10.3760/cma.j.cn321761-20210811-10003.\u003c/li\u003e\n\u003cli\u003eExpert consensus on the application of electrophysiological technology in perioperative accelerated rehabilitation of andrology[J]. Chinese Journal of Andrology, 2025, 31(03): 258-266. https://doi.org/10.13263/j.cnki.nja.2025.03.011.\u003c/li\u003e\n\u003cli\u003eLi W, Gao C, An L, et al. Perioperative transcutaneous electrical acupoint stimulation for improving postoperative gastrointestinal function: A randomized controlled trial[J]. J Integr Med, 2021, 19(3): 211-218. https://doi.org/10.1016/j.joim.2021.01.005.\u003c/li\u003e\n\u003cli\u003eKarthik N, Lodha M, Baksi A, et al. Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: A randomized controlled trial[J]. World J Surg, 2024, 48(7): 1626-1633. https://doi.org/10.1002/wjs.12233.\u003c/li\u003e\n\u003cli\u003eLi Q, Larissa T, Liu H, et al. Effectiveness of an immediate postoperative electroacupuncture session for the recovery of gastrointestinal function after laparoscopic cholecystectomy: a randomized controlled trial[J]. Acupunct Med, 2025, 43(3): 127-136. https://doi.org/10.1177/09645284251343914.\u003c/li\u003e\n\u003cli\u003eZhang Y M, Feng X Q, Zhao T Y, et al. Construction and application of a whole-process nursing management scheme for daytime surgery in patients undergoing radical prostatectomy[J]. Chinese Nursing Management, 2024, 24(02): 293-299. https://doi.org/10.3969/j.issn.1672-1756.2024.02.025.\u003c/li\u003e\n\u003cli\u003eChinese Society of Clinical Oncology Guidelines Working Committee, Zhong G, et al. Chinese Society of Clinical Oncology (CSCO) Prostate Cancer Diagnosis and Treatment Guidelines 2023[M].2023. https://lib.hust.edu.cn/asset/detail/1011192261448.\u003c/li\u003e\n\u003cli\u003eZhang J H, Guo J R, Zhou Y Z. Practical Integrated Traditional Chinese and Western Medicine Diagnosis and Therapeutics[M]. 2019. https://lib.hust.edu.cn/asset/detail/20165200220.\u003c/li\u003e\n\u003cli\u003eSpleen and Stomach Diseases Branch of Chinese Association of Traditional Chinese Medicine. Expert consensus on traditional Chinese medicine diagnosis and treatment of functional abdominal distension (2023)[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion, 2024, 32(07): 549-555. https://doi.org/10.3969/j.issn.1671-038X.2024.07.01.\u003c/li\u003e\n\u003cli\u003eNational Medical Products Administration Center for Drug Evaluation. Notice on the release of \u0026quot;Technical Guidelines for Clinical Research of New Traditional Chinese Medicines for Chronic Constipation\u0026quot; and \u0026quot;Technical Guidelines for Clinical Research of New Traditional Chinese Medicines for Diabetic Kidney Disease\u0026quot;[Z]. 2020.https://lib.hust.edu.cn/asset/detail/20868389419.\u003c/li\u003e\n\u003cli\u003eGan T J, Belani K G, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2020, 131(2): 411-448. https://doi.org/10.1213/ANE.0000000000004833.\u003c/li\u003e\n\u003cli\u003eHori T, Makino T, Fujimura R, et al. Favorable Impact on Postoperative Abdominal Symptoms in Robot-assisted Radical Prostatectomy Using Enhanced Recovery After Surgery Protocol[J]. Cancer Diagn Progn, 2022, 2(2): 247-252. https://doi.org/10.21873/cdp.10101.\u003c/li\u003e\n\u003cli\u003eShi Y F. Clinical study on umbilical moxibustion combined with transcutaneous electrical acupoint stimulation for prevention and treatment of abdominal distension after total hip arthroplasty[D]. Shandong University of Traditional Chinese Medicine, 2023. https://doi.org/10.27282/d.cnki.gsdzu.2023.000460.\u003c/li\u003e\n\u003cli\u003eHuang X, Gu H, Shen P, et al. Meta-analysis of electrical stimulation promoting recovery of gastrointestinal function after gynecological abdominal surgery[J]. World J Gastrointest Surg, 2024, 16(11): 3559-3567. https://doi.org/10.4240/wjgs.v16.i11.3559.\u003c/li\u003e\n\u003cli\u003eLu L M, Tian X. Effect of transcutaneous electrical acupoint stimulation on enteral nutrition in ICU patients with severe brain injury[J]. Shanghai Journal of Acupuncture and Moxibustion, 2022, 41(08): 786-789. https://doi.org/10.13460/j.issn.1005-0957.2022.08.0786.\u003c/li\u003e\n\u003cli\u003eLi H, Du C, Lu L, et al. Transcutaneous electrical acupoint stimulation combined with electroacupuncture promotes rapid recovery after abdominal surgery: Study protocol for a randomized controlled trial[J]. Front Public Health, 2022, 10: 1017375. https://doi.org/10.3389/fpubh.2022.1017375.\u003c/li\u003e\n\u003cli\u003eYang N, Ye Y, Tian Z, et al. Effects of electroacupuncture on the intestinal motility and local inflammation are modulated by acupoint selection and stimulation frequency in postoperative ileus mice[J]. Neurogastroenterol Motil, 2020, 32(5): e13808. https://doi.org/10.1111/nmo.13808.\u003c/li\u003e\n\u003cli\u003eMoshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review[J]. Gastroenterology, 2023, 165(3): 791-800. https://doi.org/10.1053/j.gastro.2023.04.039.\u003c/li\u003e\n\u003cli\u003eLacy B E, Cangemi D J, Wise J L, et al. Development and validation of a novel scoring system for bloating and distension: The Mayo Bloating Questionnaire[J]. Neurogastroenterol Motil, 2022, 34(8): e14330. https://doi.org/10.1111/nmo.14330.\u003c/li\u003e\n\u003cli\u003eMi Y Y, Huang P P, Wu B N, et al. Summary of best evidence for prevention and management of enteral nutrition-related abdominal distension in ICU patients[J]. Journal of Nursing Science, 2022, 37(02): 91-95. https://doi.org/10.3870/j.issn.1001-4152.2022.02.091.\u003c/li\u003e\n\u003cli\u003eNi X M, Hu S H, Han J Y, et al. Application of nurse-led bedside ultrasound in the management of abdominal distension in ICU patients receiving enteral nutrition[J]. Chinese Journal of Nursing, 2024, 59(17): 2123-2129. https://doi.org/10.3761/j.issn.0254-1769.2024.17.011.\u003c/li\u003e\n\u003cli\u003eDrossman D A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV[J]. Gastroenterology, 2016. https://doi.org/10.1053/j.gastro.2016.02.032.\u003c/li\u003e\n\u003cli\u003eMoshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review[J]. Gastroenterology, 2023, 165(3): 791-800. https://doi.org/10.1053/j.gastro.2023.04.039.\u003c/li\u003e\n\u003cli\u003eCampos D R, Bueno T B C, Anjos J S G G, et al. Early Neuromuscular Electrical Stimulation in Addition to Early Mobilization Improves Functional Status and Decreases Hospitalization Days of Critically Ill Patients[J]. Crit Care Med, 2022, 50(7): 1116-1126. https://doi.org/10.1097/CCM.0000000000005557.\u003c/li\u003e\n\u003cli\u003eWu J, Chi H, Kok S, et al. Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery[J]. Ann Coloproctol, 2024, 40(1): 3-12. https://doi.org/10.3393/ac.2022.01207.0172.\u003c/li\u003e\n\u003cli\u003eSzmit M, Krajewski R, Rudnicki J, et al. Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review[J]. Adv Clin Exp Med, 2023, 32(9): 1063-1074. https://doi.org/10.17219/acem/159703.\u003c/li\u003e\n\u003cli\u003eChen X, Zhang Y X, Zhou H Y, et al. Summary of best evidence for non-pharmacological management of postoperative nausea and vomiting[J]. Chinese Journal of Nursing, 2021, 56(11): 1721-1727. https://doi.org/10.3761/j.issn.0254-1769.2021.11.021.\u003c/li\u003e\n\u003cli\u003eZhang L, Song K C, Shen L. Multimodal postoperative nausea and vomiting management strategy driven by the concept of enhanced recovery after surgery: Interpretation of \u0026quot;Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting\u0026quot;[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(04): 490-495. https://doi.org/10.12290/xhyxzz.2021-0189.\u003c/li\u003e\n\u003cli\u003eYuan L, Quan S, Li X, et al. Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after laparoscopic surgery: A meta-analysis[J]. J Nurs Scholarsh, 2025, 57(3): 371-379. https://doi.org/10.1111/jnu.13033.\u003c/li\u003e\n\u003cli\u003eSzmit M, Krajewski R, Rudnicki J, et al. Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review[J]. Advances in clinical and experimental medicine: official organ Wroclaw Medical University, 2023, 32(9): 1063-1074. https://doi.org/10.17219/acem/159703.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prostate cancer, Laparoscopy, Abdominal distension, Transcutaneous electrical acupoint stimulation (TEAS), Simethicone, Early intervention","lastPublishedDoi":"10.21203/rs.3.rs-8669687/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8669687/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative gastrointestinal dysfunction is a common complication following laparoscopic radical prostatectomy, significantly impairing patient recovery. Timely pharmacological and physical interventions can effectively promote gastrointestinal function recovery. This study aimed to evaluate the efficacy of early transcutaneous electrical acupoint stimulation (TEAS) combined with oral simethicone in alleviating postoperative abdominal distension in prostate cancer patients, providing evidence for optimizing the timing and methods of postoperative interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on 138 patients who underwent radical prostatectomy at a hospital in Wuhan from February 2025 to November 2025. All cases were from the same surgical team and were divided into three groups based on medical orders: (1) Control group (n=46, standard care), (2) TEAS + simethicone group (n=46, TEAS and simethicone initiated on postoperative day 1), and (3) Early TEAS + simethicone group (n=46, TEAS and simethicone initiated immediately after surgery). Outcome measures included abdominal distension severity on postoperative days 1–3, time to first flatus, defecation within 3 days, and incidence of postoperative nausea and vomiting (PONV).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding abdominal distension: On the first postoperative day, there was no significant difference in the severity of abdominal distension among the three groups (\u003cem\u003eP\u003c/em\u003e\u0026gt; 0.05); on the second postoperative day, the incidence of abdominal distension in the early electrical stimulation combined group (21.74%) was lower than that in the control group (45.65%), and the number of patients with severe abdominal distension (6.52%) was also lower than that in the control group (28.26%); on the third postoperative day, the incidence of abdominal distension in the electrical stimulation combined group (21.74%) and the early electrical stimulation combined group (23.91%) was significantly lower than that in the control group (42.48%), and the difference was statistically significant (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01). Regarding the time of first defecation: There was a statistically significant difference among the three groups of patients. The early electrical stimulation combined group (22.07 ± 9.27 hours) was significantly shorter than the control group (28.33 ± 11.85 hours); in terms of the number of patients defecating on the third postoperative day: There was a difference among the three groups of patients. The early electrical stimulation combined group (30.43%) had more patients than the control group (10.87%); in terms of the incidence of nausea and vomiting: There was no statistically significant difference among the three groups of patients (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly TEAS combined with oral simethicone effectively reduces postoperative abdominal distension, accelerates gastrointestinal recovery, and promotes earlier bowel movements in prostate cancer patients. These findings suggest that combined pharmacological and physical therapy should be initiated as early as possible to improve postoperative gastrointestinal dysfunction.\u003c/p\u003e","manuscriptTitle":"Early TEAS Combined with Simethicone for Accelerated Gastrointestinal Recovery after Prostate Cancer Surgery: A case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-24 16:00:11","doi":"10.21203/rs.3.rs-8669687/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-18T14:26:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-17T15:06:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-23T13:12:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-23T13:06:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2026-01-22T11:44:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"94509133-2fd0-4af5-a23e-59b38acc38d2","owner":[],"postedDate":"March 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T16:00:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-24 16:00:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8669687","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8669687","identity":"rs-8669687","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}