The contribution of mast cells to postoperative ileus in experimental and clinical studies

Abstract

The persistent phase of postoperative ileus (POI) is mediated by inflammatory activation of the resident myeloid immune cell population in the gut wall, likely elicited by neurogenic activation. Mast cells are thought to play a critical role in this inflammatory response and involvement of mast cells in POI has been investigated and described thoroughly in experimental studies. Intestinal manipulation (IM) leads to degranulation of mast cells, resulting in an increase in mast cell proteases in peritoneal fluid and gut tissue. The inflammatory infiltrate formed in the intestinal wall thereby impairs gastrointestinal motility. In the clinical study by Berdun et al., the experimentally known association between mast cell degranulation and delayed motility is shown in a clinical setting. These findings are important and open up therapeutic opportunities to reduce or prevent POI. In this mini-review, the role of mast cells in POI is discussed. Furthermore, an update is given on the involvement of the inflammatory response in POI and potential therapeutic strategies.

Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

“…, a correlation between POI and AL was also demonstrated. The current results support the experimental findings that systemic inflammation is important in POI .…”

“…In a cross-check analysis, evaluating the data of a randomized controlled trial conducted by Boelens et al [9], a correlation between POI and AL was also demonstrated. The current results support the experimental findings that systemic inflammation is important in POI [21,22]. Over the last 20 years surgical technique [23] and perioperative regimes [24] have evolved and scoring systems for AL have been developed [25,26].…”

Postoperative ileus following major colorectal surgery

“…This is due to a time‐ and procedure‐dependent inflammatory response to intestinal handling. Mast cells and damage‐associated molecule patterns are thought to play a critical role in this process by activating macrophages of the bowel muscularis. The actions of mast cells lead to an altered mucosal barrier to luminal bacteria, aspects of which are due to toll‐like receptors that display remarkable interspecies homology.…”

The clinical and economical impact of postoperative ileus in patients undergoing colorectal surgery

“…In particular, postoperative ileus (POI) is affecting 10%‐40% of patients undergoing a colorectal resection and is an important clinical determinant of short‐term morbidity 1 . POI is often seen as an inevitable complication of abdominal surgery, and attempts have been made to reduce the incidence by enhanced recovery after surgery protocols, less opioid use and studies investigating the use of chewing gum 2 . Still, POI is leading to discomfort, impaired recovery, a prolonged length of hospital stay, reoperation and readmission 3,4 .…”