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Abstract
Postoperative ileus (POI) has long been a challenging clinical problem for both patients and healthcare physicians alike. Although a standardized definition does not exist, it generally includes symptoms of intolerance to diet, lack of passing stool, abdominal distension, or flatus. Not only does prolonged POI increase patient discomfort and morbidity, but it is possibly the single most important factor that results in prolongation of the length of hospital stay with a significant deleterious effect on healthcare costs in surgical patients. Determining the exact pathogenesis of POI is difficult to achieve; however, it can be conceptually divided into patient-related and operative factors, which can further be broadly classified as neurogenic, inflammatory, hormonal, and pharmacological mechanisms.Different strategies have been introduced aimed at improving the quality of perioperative care by reducing perioperative morbidity and length of stay, which include Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical approaches, and the use of specific pharmaceutical therapies. Recent studies have shown that the ERAS pathway and laparoscopic approach are generally effective in reducing patient morbidity with early return of gut function. Out of many studies on pharmacological agents over the recent years, alvimopan has shown the most promising results. However, due to its potential complications and cost, its clinical use is limited. Therefore, this article aimed to review the pathophysiology of POI and explore recent advances in treatment modalities and prevention of postoperative ileus.
Highlights
BackgroundPostoperative ileus (POI) is considered as intolerance of oral intake due to disruption of the normal coordinated propulsive motor activity of the gastrointestinal (GI) tract following abdominal or nonabdominal surgery, without any mechanical element [1-3]
Gum chewing, which is another component of Enhanced Recovery After Surgery (ERAS), has been used commonly for early recovery from POI as it leads to vagal stimulation and increases gastrointestinal secretions, increases gut motility, and reduces inhibitory sympathetic signals [38]
Postoperative ileus is a physiological response of the body due to disruption of bowel motility
Summary
Postoperative ileus (POI) is considered as intolerance of oral intake due to disruption of the normal coordinated propulsive motor activity of the gastrointestinal (GI) tract following abdominal or nonabdominal surgery, without any mechanical element [1-3]. Gum chewing, which is another component of ERAS, has been used commonly for early recovery from POI as it leads to vagal stimulation and increases gastrointestinal secretions, increases gut motility, and reduces inhibitory sympathetic signals [38] It increases salivary and pancreatic secretions, and some sugars found in sugar-free gum have been reported to reduce postoperative ileus [39,40]. There are several pharmacological therapies, including carbohydrate loading, use of non-steroidal antiinflammatory drugs (NSAIDs), prophylactic anti-emetics, and epidural and regional analgesia, all of which are an integral part of the ERAS pathways These therapeutic modalities have been well known to have a significant impact on the early return of gut function as shown in a review by Kehlet et al [60]. GI: Gastrointestinal; POI: Postoperative ileus; DOCIVA: Decrease opioid consumption with intravenous (IV) acetaminophen after colorectal surgery; SQ: Subcutaneous
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