A Comprehensive Review of Evidence-Based Strategies to Prevent and Treat Postoperative Ileus

Abstract

Background: Postoperative ileus (POI) is a common complication of abdominal and several other surgeries leading to increased hospital stay and healthcare costs. POI also contributes towards numerous postsurgical comorbidities including deep vein thrombosis and pneumonia. POI is characterized by bowel distention and lack of bowel sounds, flatus and bowel movements. The causative mechanism is not fully understood and may be multifactorial including disorganized electrical activity, activation of inflammatory mediators and the use of opioid analgesics. Methods: A selective review of the literature pertaining to the prevention and treatment of adynamic ileus and POI was completed. More specifically we sought to evaluate RCTs, meta-analyses, consensus statements and articles providing graded evidence-based data on POI prevention and treatment. Results: Perioperative strategies employed to prevent or limit the duration of POI include avoidance of preoperative fasting and mechanical bowel preparation, use of epidural-local anesthetics, implementation of minimally-invasive surgical techniques, and modification of pain management strategies to limit opioid administration among others. Conclusion: Though many of these strategies have proven beneficial, no single approach has demonstrated the ability to prevent or treat POI. However, when these strategies are used in combination as part of a fast-track multimodal treatment plan, there is a significant decrease in time to return of normal bowel function and a shortened hospital stay. Additional studies are needed to make specific recommendations regarding which components of fast-track protocols are most beneficial.

Rice Cake Ileus - A Rare and Ethnic but Important Disease Status in East-Southern Asia

“…All cases improved by merely a conservative therapy. In contrast, postoperative ileus occasionally requires an operation (10).…”

Postoperative Ileus in Elective Colorectal Surgery: Management Strategies

“…Nonetheless, our understanding of pathophysiology of ileus is better than before and a number of strategies to overcome the causative factors have been tried (Stewart and Waxman 2010;Story and Chamberlain 2009). Although such strategies help reduce the duration of ileus, they have limited role in preventing its onset (Lubawski and Saclarides 2008).…”

“…Nevertheless, it is established that laparoscopic surgery, in general, is associated with reduced post operative pain and inflammatory response. Consequently, it may play a role in reducing the incidence of POI (Story and Chamberlain 2009). More work is underway in this area and evidence is eagerly awaited.…”

The physiotherapy management of patients undergoing abdominal surgery

“…There is a widespread belief that early ambulation assists in the resolution of gut immotility and prevention of paralytic ileus, yet there is no conclusive evidence to support this hypothesis (Story and Chamberlain 2009). Indeed, there is stronger evidence for the routine use of chewing gum, which stimulates the neurohormonal response to eating and enhances the resolution of a normal gut peristalsis, to prevent paralytic ileus and reduce LOS , than there is for early ambulation.…”