Postoperative ileus: strategies for reduction

Abstract

Postoperative Ileus (POI) is a frequent, frustrating occurrence for patients and surgeons after abdominal surgery. Despite signifi cant research investigating how to reduce this multi-factorial phenomenon, a single strategy has not been shown to reduce POI's signifi cant effects on length of stay (LOS) and hospital costs. Perhaps the most signifi cant cause of POI is the use of narcotics for analgesia. Strategies that target infl ammation and pain reduction such as NSAID use, epidural analgesia, and laparoscopic techniques will reduce POI but are accompanied by a simultaneous reduction in opioid use. Pharmacologic means of stimulating gut motility have not shown a positive effect, and the routine use of nasogastric tubes only increases morbidity. Recent multi-site phase III trials with alvimopan, a peripherally acting mu-antagonist, have shown signifi cant reductions in POI and LOS by 12 and 16 hours, respectively, by blunting the effects of narcotics on gut motility while sparing centrally mediated analgesia. Use of alvimopan, along with a multi-modal postoperative treatment plan involving early ambulation, feeding, and avoiding nasogastric tubes, will likely be the crux of POI treatment and prevention.

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

“…Nanomollar EA fully recovered CCh-induced mI CAT suppressed by ketamine ( Figure 5C). These findings not only contribute to our better understanding of the limited usefulness of anticholinesterases (drugs that reduce breakdown of the physiological neurotransmitter acetylcholine) for the treatment of POI (Lubawski and Saclarides, 2008), but also show that the activity of the muscarinic cation channels initiating cholinergic excitation-contraction coupling in the gut could be restored by channel agonists that do not require activation of mAChRs and G-proteins.…”

“…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).…”

The influence of diabetes on postoperative complications following colorectal surgery

“…Ramsey et al [ 64 ] found insulin-dependent diabetes to be a significant risk factor for the occurrence of ileus following colectomy (OR 1.40, 95% CI 1.30–1.49, p < 0.001). The increased occurrence of ileus after colectomy was attributed to damage to myenteric neurons from chronic diabetes [ 88 ], which is a common cause of diabetes-associated gastrointestinal complications. This is corroborated by previous studies which have suggested diabetes as a significant risk factor for postoperative ileus in abdominal surgery [ 89 ].…”

Fast-track- recovery surgery with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively among surgical gynaecological cancer patients: study protocol of an open-labelled, randomised controlled trial

“…After a major operation, conventional post-operative care usually includes restrict oral intake to prevent postoperative ileus and, thus, to protect surgical anastomoses [34]. The other reason for nil-by-mouth post operation is to allow anastomoses time to heal before being stressed by the food transiting the gut [35].…”