State-of-the-art colorectal disease: postoperative ileus

Abstract

Purpose Postoperative Ileus (POI) remains an important complication for patients after abdominal surgery with an incidence of 10–27% representing an everyday issue for abdominal surgeons. It accounts for patients’ discomfort, increased morbidity, prolonged hospital stays, and a high economic burden. This review outlines the current understanding of POI pathophysiology and focuses on preventive treatments that have proven to be effective or at least show promising effects. Methods Pathophysiology and recommendations for POI treatment are summarized on the basis of a selective literature review. Results While a lot of therapies have been researched over the past decades, many of them failed to prove successful in meta-analyses. To date, there is no evidence-based treatment once POI has manifested. In the era of enhanced recovery after surgery or fast track regimes, a few approaches show a beneficial effect in preventing POI: multimodal, opioid-sparing analgesia with placement of epidural catheters or transverse abdominis plane block; μ-opioid-receptor antagonists; and goal-directed fluid therapy and in general the use of minimally invasive surgery. Conclusion The results of different studies are often contradictory, as a concise definition of POI and reliable surrogate endpoints are still absent. These will be needed to advance POI research and provide clinicians with consistent data to improve the treatment strategies.

Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn’s disease

“…Postoperative management should be standardized in a fast-track regime, including multimodal opioid-sparing analgesia using μ-opioid-receptor antagonists, epidural catheters and transverse abdominis plane block, early mobilization and oral nutrition, and goal-directed fluid therapy. Addittionaly, minimally invasive surgical approaches are recommended [ 41 ]. Kono-S anastomosis should be preferred in patients with CD undergoing an ileocecal resection, as it results in a wide anastomosis with significantly reduced recurrence rates of CD although it represents a hand-sewn anastomosis [ 42 ].…”

The Role of Inflammatory Mediators in the Development of Gastrointestinal Motility Disorders

“…In a 2008 Cochrane Review of drugs to treat POI, erythromycin (used to treat ileus in the US) was shown to be ineffective for the treatment of ileus and the effects were inconsistent or insufficient evidence was available to recommend any other drugs, including serotonin agonists (cisapride), dopamine antagonists (metoclopramide), beta-blockers (propranolol), vasopressin, or cholecystokinin-like drugs (cerulatide) [19]. In a more recent review by Sommer et al, the authors concluded that although preventative methods have advanced, there are no evidence-based effective treatments for ileus once it develops [20]. Furthermore, several drugs to treat ileus have significant deleterious side effects that limit their use [19].…”

Post‐operative ileus: definitions, mechanisms and controversies

“…Most current preventative strategies are non‐specific and act by reducing the post‐operative inflammatory response, limiting opiate use and avoiding fluid overload, 9,11,12 yet despite these efforts, POI remains a common and troublesome issue following abdominal surgery. While there are promising developments, existing research has been limited by inconsistent definitions and an incomplete understanding of underlying pathophysiology 11 . This review aims to highlight controversies in the definitions and mechanisms of ileus, and identify areas for further research.…”

“…While there are promising developments, existing research has been limited by inconsistent definitions and an incomplete understanding of underlying pathophysiology. 11 This review aims to highlight controversies in the definitions and mechanisms of ileus, and identify areas for further research.…”

“…[6][7][8] Few effective therapies for POI or PPOI exist, although many interventions have been tried. 9,10 Most current preventative strategies are non-specific and act by reducing the post-operative inflammatory response, limiting opiate use and avoiding fluid overload, 9,11,12 yet despite these efforts, POI remains a common and troublesome issue following abdominal surgery. While there are promising developments, existing research has been limited by inconsistent definitions and an incomplete understanding of underlying pathophysiology.…”