Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment.

Abstract

Postoperative ileus (POI) is a frequent complication after abdominal surgery; nonetheless, it remains poorly defined. Our aim was to achieve an international consensus among leading colorectal surgeons on definition, prevention, and treatment of POI. Thirty-five experts from five continents participated in a three-round Delphi process. Round 1 contained open-ended questions on POI and postoperative nausea and vomiting (PONV). Round 2 included closed-ended questions. Round 3 measured agreement on a 5-point Likert scale. Consensus was defined when items were rated as agree or strongly agree by at least 70% of the experts. Experts reached following consensus: POI is a temporary inhibition (86%) of gastrointestinal motility after surgical intervention due to non-mechanical causes (89%) and prevents sufficient oral intake (96%). Abdominal distension/tenderness are the most relevant clinical signs (71%). Nasogastric tube placement is not mandatory (78%) but can be removed without previous clamping (81%)/gastrointestinal contrast study (100%). Preventive measures are recommended to decrease the risk of POI (96%): narcotic sparing analgesia (89%) and fluid optimization (74%). Treatment of POI should include stimulation of ambulation (96%) and stop of opioids (74%). Total parenteral nutrition is recommended from the 7th day without sufficient oral intake (81%). There was no consensus on the ranking of POI's symptoms, on the imaging modality of choice for the diagnosis of POI, neither on the difference between POI and PONV. This Delphi study achieved consensus on the definition, relevant clinical signs, prevention, treatment, and supportive care of POI. Areas of non-consensus were identified (necessity and modality of radiologic imaging to establish the diagnosis, difference between POI and PONV), giving opportunity for further research.