Postoperative ileus: Recent developments in pathophysiology and management

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

“…These include increasing age, male gender, low pre‐operative serum albumin, acute and chronic opioid use, previous abdominal surgery, pre‐existing airways and vascular disease, long duration of surgery, emergency surgery, blood loss and salt and water overload. Most of these factors increase the inflammatory response, and inflammation and oedema play a major role in reducing intestinal smooth muscle contractility 74. ERAS principles are aimed at reducing perioperative stress and inflammation and, hence, can reduce the duration of ileus and accelerate recovery of gut function post‐operatively.…”

Effect of Acupressure on Symptoms of Postoperative Ileus After Cesarean Section

“…The exclusion criteria were as follows: postoperative use of acute and chronic opioid, age older than 45 years, received spinal analgesia during surgery, having preexisting airways and peripheral vascular disease. However, patients who required stomas, underwent blood loss (>1000 mL) and needed transfusion, had thyroid disorders or nervous, muscular, and hepatic diseases [1] or developed intraoperative problems or complications during cesarean section, including hysterectomy and abnormal bleeding, were excluded from the study.…”

“…Patients who are older, male, and have low preoperative albumin, acute, and chronic opioid use, previous abdominal surgery, preexisting airways/peripheral vascular disease, long duration of surgery, emergency surgery, blood loss, and need for transfusion and procedures requiring stomas are at higher risk of developing POI [1]. Previous studies showed that 19% of hospitalized patients undergo the course of POI, which extends their hospital stay by 1.5e5.5 days on average, costing about $1.46 billion in the United States annually [7].…”

“…The term ileus refers to a blockage of the intestines that can ensue for both mechanical and nonmechanical reasons. POI has been characterized by abnormal pattern of gastrointestinal (GI) motility, including failure of GI peristalsis [1]. Ileus may indicate different kind of situations, e.g., paralytic intestine, and/or pathologic response of intestine to stimulations and trauma.…”

“…Consequently, some strategies are suggested to prevent POI incidence including chewing gum, carbohydrate loading, and laparoscopic surgery, prescription of nonsteroidal antiinflammatory drugs, and decreased use of intravenous opioids. With increasing knowledge of POI pathophysiology, traditional treatments are being combined with and directed toward more novel interventions [1]. One form of traditional medical treatment that combines and merges with new medicine is acupuncture.…”