Postoperative ileus: Pathophysiology, incidence, and prevention

Venara, Aurélien; Neunlist, Michel; Slim, K.; Barbieux, J.; Colas, Pierre; Hamy, A.; Meurette, G.

doi:10.1016/j.jviscsurg.2016.08.010

Cited by 265 publications

(257 citation statements)

References 79 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Wang²,

Liang³

et al. 2017

Medicine

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Background:The aim of this study was to assess the safety and effectiveness of robotic-assisted versus laparoscopic total mesorectal excision (TME) in patients with rectal cancer.Methods:We systematically searched PubMed, EMBASE, Cochrane library, Web of science, and Chinese Biomedical Literature Database up to July 2016 to identify case-controlled studies that compared robotic TME (RTME) with laparoscopic TME (LTME) for rectal cancer. GRADE was used to interpret the primary outcomes of this meta-analysis.Results:We included 17 case–control studies (3601 participants: 1726 underwent RTME and 1875 LTME for rectal cancer) that compared RTME with LTME for rectal cancer. We found no statistically significant differences between techniques for local recurrence [odds ratio (OR) = 0.68, P = .216] and overall survival at 3 years (OR = 0.71, P = 1.140), complications (OR = 1.02, P = .883), positive circumferential resection margin (PCRM) (OR = 0.80, P = .256), the first passing flatus [weighted mean difference (WMD) = −0.11, P = .130], reoperation (OR = 0.66, P = .080), estimated blood loss (EBL) (WMD = −12.45, P = .500), and length of stay in hospital (LOS) (WMD = −0.69, P = .089). Compared with LTME, RTME was associated with lower rate of conversion (OR = 0.35, P < .001), urinary retention (OR = 0.41, P = .025), and longer operative time (WMD = 57.43, P < .001). The overall quality of evidence was poor in all outcomes.Conclusion:RTME in patients with rectal cancer was associated with a lower rate of conversion and less incidence of urinary retention. Generally, operative time in RTME was significantly longer than in LTME. The long-term oncological and function outcomes of RTME seem to be equivalent with LTME. Therefore, analysis of current studies to date did not indicate a major benefit of RTME over LTME.

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Section: Discussionmentioning

confidence: 99%

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

Wang²,

Liang³

et al. 2017

Medicine

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“…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.…”

Section: General and Humanmentioning

confidence: 99%

“…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.…”

Section: General and Humanmentioning

confidence: 99%

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

Lisowski

Pirie

Blikslager

et al. 2018

Equine Veterinary Journal

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Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Yang

Tian

et al. 2020

Neurogastroenterology Motil

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Postoperative ileus (POI) is a frequent complication of abdominal surgery characterized by transient hypomotility of the gastrointestinal tract and presents as an inability to tolerate enteral nutrition, nausea, and lack of passage of flatus and stool, along with abdominal distension. 1 Acute early activation of inhibitory neural pathways and secondary late inflammatory responses are considered to be the main pathological mechanisms of POI. 2 This condition accounts for prolonged hospitalization and increased risks of aspiration and infectiousAbstract Background: Electroacupuncture (EA) is widely used in various gastrointestinal diseases around the world, including POI. Here, we investigated different therapeutic effects of EA using lower limb and abdomen acupoints. Methods: Intestinal manipulation was performed in 88 mice, and eight mice underwent a sham operation. Forty mice were randomly divided into model group and four EA groups receiving stimulation at ST36 (2, 10, 30, 100 Hz). The most effective frequency was then used in the following experiments. Forty-eight mice were randomly divided into six groups receiving EA treatment at ST37, ST39, ST25, CV4, CV12, and a non-acupuncture point. Gastrointestinal motility and plasma TNF-α, IL-6 were evaluated in all mice. The local immune response and α-smooth muscle actin (α-SMA) expression were assessed by immunofluorescence, ELISA, and HE staining.Results: ST36 stimulated with 10 or 30 Hz EA significantly increased the gastrointestinal motility and attenuated peripheral inflammation; however, ST36 stimulated with 2 or 100 Hz did not induce any effect. The therapeutic effects on motility and inflammation of 10 Hz EA in the ST36 group were similar in the ST36, ST37, ST39, or CV4 groups, but when applied to ST25, CV12 or non-acupoint had no significant differences. EA at ST36, ST37, ST39, or CV4 significantly inhibited local MPO activity, immune cells infiltration, and increased α-SMA.Conclusions: EA at lower limb and abdomen acupoints with the same stimulation parameters had different therapeutic effects on postoperative dysmotility and inflammation. Furthermore, EA protected SMC to improve gastrointestinal transit by reducing local inflammation in the intestinal musculature in POI. K E Y W O R D Sacupoints, gastrointestinal motility, myeloperoxidase, α-SMA

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Postoperative ileus: Pathophysiology, incidence, and prevention

Cited by 265 publications

References 79 publications

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

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

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

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

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