Postoperative ileus: Pathophysiology, incidence, and prevention

Abstract

Postoperative ileus (POI) is a major focus of concern for surgeons because it increases duration of hospitalization, cost of care, and postoperative morbidity. The definition of POI is relatively consensual albeit with a variable definition of interval to resolution ranging from 2 to 7 days for different authors. This variation, however, leads to non-reproducibility of studies and difficulties in interpreting the results. Certain risk factors for POI, such as male gender, advanced age and major blood loss, have been repeatedly described in the literature. Understanding of the pathophysiology of POI has helped combat and prevent its occurrence. But despite preventive and therapeutic efforts arising from such knowledge, 10 to 30% of patients still develop POI after abdominal surgery. In France, pharmacological prevention is limited by the unavailability of effective drugs. Perioperative nutrition is very important, as well as limitation of preoperative fasting to 6 hours for solid food and 2 hours for liquids, and virtually no fasting in the postoperative period. Coffee and chewing gum also play a preventive role for POI. The advent of laparoscopy has led to a significant improvement in the recovery of gastrointestinal function. Enhanced recovery programs, grouping together all measures for prevention or cure of POI by addressing the mechanisms of POI, has reduced the duration of hospitalization, morbidity and interval to resumption of transit.

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

“…Risk factors for postoperative bowel obstruction were associated with male gender, advanced age, significant blood loss, the surgical approach used, intro-abdominal infection, anastomotic leak, emergency surgery, and opioid administration. [44] In 1 study, the investigators highlighted opioids’ role in aggravating the risk for postoperative bowel obstruction. [45] Our meta-analysis demonstrated that operative time was visibility longer for RTME than LTME, suggesting that patients were administered more anesthetics, especially opioids.…”

An update on equine post‐operative ileus: Definitions, pathophysiology and management

“…For example, the reported incidence of human POI ranges from 2% to 60% depending on the POI or PPOI descriptors applied in the study [2,19]. The criteria used for classification vary greatly, which probably contributes to the disparity in certain study-derived data.…”

“…The criteria used for classification vary greatly, which probably contributes to the disparity in certain study-derived data. For example, the reported incidence of human POI ranges from 2% to 60% depending on the POI or PPOI descriptors applied in the study [2,19]. Efforts to establish more specific criteria for each of these POI subcategories [2] might facilitate comparisons between individual studies.…”

Effects of electroacupuncture on the intestinal motility and local inflammation are modulated by acupoint selection and stimulation frequency in postoperative ileus mice

“…Intestinal manipulation can stimulate innate immune cells and lead to an inflammatory response, altering the immune system and subsequently our inflammatory status in POI . Previous studies have pointed to an adipose local immune response after intestinal manipulation as the main cause of inflammation in POI . Intestinal inflammation is associated with increased myeloperoxidase (MPO) enzyme activity in the intestines.…”