Postoperative Ileus

Abstract

Postoperative ileus (POI) is a common complication following colon and rectal surgery, with reported incidence ranging from 10 to 30%. It can lead to increased morbidity, cost, and length of stay. Although definitions vary considerably in the literature, in its pathologic form, it can be characterized by a temporary inhibition of gastrointestinal motility after surgical intervention due to nonmechanical causes that prevents sufficient oral intake. Various risk factors for development of POI have been identified including increasing age, American Society of Anesthesiologists scores 3 to 4, open approach, operative difficulty, operative duration more than 3 hours, bowel handling, drop in hematocrit or need for a transfusion, increasing crystalloid administration, and delayed mobilization. While treatment is expectant and supportive, significant investigations into strategies to mitigate development of POI or shorten its duration have been undertaken with mixed results. There is significant evidence to suggest that a minimally invasive approach and multimodal pain regimens reduce the development of POI. The beneficial effect of chewing gum, alvimopan, and enhanced recovery after surgery protocols may decrease development of POI in selected groups of patients who undergo elective colorectal surgery, and shorten time to return of bowel function, but overall, the data remain inconclusive.

Robotic or laparoscopic surgery for rectal cancer - which is the best answer? a comprehensive review of non-oncological outcomes and learning curve

“…Data collected across all surgery specialties demonstrates that operative time was 30 min longer in patients with surgical site infections than in those without [14] . Increased operative time has also been shown to result in higher rates of ileus and length of stay [15,16] .…”

Perspectives on paralytic ileus

“…Small bowel motility returns within a few hours and gastric and colonic motility after a few days, depending on the degree of trauma. 1,3 It might be prolonged if there is hypokalemia, hypoproteinemia, or renal failure or if the bowel is allowed to get grossly distended. 4 Uremia could also produce ileus, often with distention, vomiting, and hiccups.…”

Suppression of mICAT in Mouse Small Intestinal Myocytes by General Anaesthetic Ketamine and its Recovery by TRPC4 Agonist (-)-englerin A

“…Our interest has been prompted by the still unresolved problem of one of the GI motility disorders-postoperative ileus (POI), which imposes a significant economic burden on the healthcare system (Iyer et al, 2009) and for which there is no effective pharmacological treatment (Lubawski and Saclarides, 2008;Harnsberger et al, 2019).…”