Treatment Of Postoperative Ileus Research Articles

The Effect of CKD-495, Eupacidin, and Their Marker Compounds on Altered Permeability in a Postoperative Ileus Animal Model.

Background and Objectives: Postoperative ileus (POI) is a delay in gastrointestinal transit following surgery that leads to various complications. There is limited understanding of its effective treatment options. CKD-495 and eupacidin are natural products licensed for treating mucosal lesions in acute and chronic gastritis; however, little is known about their effects on intestinal permeability. This study evaluated the effects of CKD-495, eupacidin, and its components (eupatilin and cinnamic acid) on intestinal permeability in an animal model of POI. Materials and Methods: Guinea pigs underwent surgical procedures and were randomly assigned to different treatment groups. Drugs were administered orally prior to surgery. Intestinal permeability, leukocyte count, and the expression of calprotectin and tight junction proteins were measured in the harvested ileum tissue. Results: The intestinal permeability and leukocyte count were higher in the POI group than in the control group. The pre-administration of CKD-495, cinnamic acid, eupacidin, and eupatilin effectively prevented these changes in the POI model. No significant differences were observed in the expression of tight junction proteins. Conclusions: CKD-495, cinnamic acid, eupacidin, and eupatilin exerted protective effects against increased intestinal permeability and inflammation in an animal model of POI. These natural products have potential as therapeutic options for the treatment of POI.

Effectiveness of acupuncture combined with auricular acupressure in the treatment of postoperative ileus: a study protocol for a randomized controlled trial.

About one-third of patients experience postoperative ileus (POI) after abdominal surgery, which can cause various complications and has not been treated well in clinical practice. The comprehensive treatment offered by traditional Chinese medicine may be a good choice for promoting intestinal mobility. Therefore, the aim of this study protocol is to observe the effectiveness of acupuncture combined with auricular acupressure in decreasing the incidence and related symptoms of POI. This is a single-center, assessor-blinded, randomized controlled trial. A total of 160 participants are supposed to recruit at Shanghai Tenth People's Hospital and randomly divided into two parallel groups in a 1:1 ratio. The intervention group are planned to receive manual acupuncture combined with auricular acupressure, while the control group are planned to receive regular enhanced recovery after surgery treatment. The primary outcome is the time to first defecation and first flatus after surgery. The secondary outcomes include the length of postoperative hospital stay, intensity of postoperative abdominal pain and distension, severity of postoperative nausea and vomiting, time to tolerate diet, inflammatory index, and incidence of prolonged postoperative ileus. The results of this research will provide substantial evidence regarding the efficacy of comprehensive traditional Chinese treatment, specifically auricular acupressure and manual acupuncture, in treating and preventing POI. ClinicalTrials.gov, Identifier: ChiCTR2300075983, registered on September 21, 2023.

Electroacupuncture treatment improves postoperative ileus by inhibiting the Th1 cell-mediated inflammatory response through the vagus nerve.

Electroacupuncture (EA) has been reported to improve intestinal motility in mice with postoperative ileus (POI). Previous studies, however, have yielded heterogeneous results regarding the effect of EA on POI. Herein, a POI mouse model was constructed by intestinal manipulation. To evaluate the effect of EA treatment on colonic transit, the levels of inflammatory markers (macrophage inflammatory protein (MIP)-1α, interleukin (IL)-1β, IL-6, monocyte chemotactic protein (MCP)-1 and intercellular adhesion molecule (ICAM)-1) were detected by enzyme-linked immunosorbent assay (ELISA); immune cell infiltration was detected by immunohistochemical staining of myeloperoxidase (MPO), ectodysplasin (ED)-1 and ED-2, and the percentage of CD4+ interferon (IFN)-γ+ Th1 cells and IFN-γ secretion levels were determined. Activated Th1 cells and pentoxifylline, a cell differentiation inhibitor, were used to assess the role of Th1 cells in EA treatment of POI. Neostigmine administration and unilateral vagotomy were performed to confirm whether the effects of EA treatment on Th1 cells were mediated by the vagus nerve (VN). The results revealed that EA treatment at ST36 improved POI, as indicated by a decreased level of inflammatory-related markers and immune cell infiltration and shortened colonic transit time. The activated Th1 cells abolished the effects of EA treatment on POI. The effects of EA treatment on POI were enhanced by stimulation of the VN along with a decreased level of Th1 cells, but these effects were abolished by vagotomy along with an increased percentage of Th1 cells; this result indicates that the VN mediates the role of Th1 cells in the effects of EA treatment of POI. Our findings showed that the effects of EA treatment of POI were mainly mediated by Th1 cells through the stimulation of the VN and inhibition of the inflammatory response.

Electroacupuncture alleviates intestinal inflammation via a distinct neuro-immune signal pathway in the treatment of postoperative ileus

BackgroundThe induction of intestinal inflammation as a result of abdominal surgery is an essential factor in postoperative ileus (POI) development. Electroacupuncture (EA) at ST36 has been demonstrated to relieve intestinal inflammation and restore gastrointestinal dysmotility in POI. This study aims to elucidate the neuroimmune pathway involved in the anti-inflammatory properties of EA in POI. MethodsAfter intestinal manipulation (IM) was performed to induce POI, intestinal inflammation and motility were assessed 24 h post-IM, by evaluating gastrointestinal transit (GIT), cytokines expression, and leukocyte infiltration. Experimental surgery, pharmacological intervention, and genetic knockout mice were used to elucidate the neuroimmune mechanisms of EA. ResultsEA at ST36 significantly improved GIT and reduced the expression of pro-inflammatory cytokines and leukocyte infiltration in the intestinal muscularis following IM in mice. The anti-inflammatory effectiveness of EA treatment was abolished by sub-diaphragmatic vagotomy, whereas splenectomy did not hinder the anti-inflammatory benefits of EA treatment. The hexamethonium chloride (HEX) administration contributes to a notable reduction in the EA capacity to suppress inflammation and enhance motility dysfunction, and EA is ineffective in α7 nicotinic acetylcholine receptor (α7nAChR) knockout mice. ConclusionsEA at ST36 prevents intestinal inflammation and dysmotility through a neural circuit that requires vagal innervation but is independent of the spleen. Further findings revealed that the process involves enteric neurons mediating the vagal signal and requires the presence of α7nAChR. These findings suggest that utilizing EA at ST36 may represent a possible therapeutic approach for POI and other immune-related gastrointestinal diseases.

Efficacy of Naldemedine on Intestinal Hypomotility and Adhesions in Rodent Models of Postoperative Ileus.

Postoperative ileus (POI) often decreases patients' QOL because of prolonged hospitalization and readmission. Alvimopan, a peripheral μ-opioid receptor antagonist, is currently the only therapeutic drug for POI. The aim of this study was to examine the efficacy of naldemedine (a peripheral μ-opioid receptor antagonist with a non-competitive pharmacological profile different from that of alvimopan) on postoperative intestinal hypomotility and adhesion in rodent models, and compare it with the effects of alvimopan. Oral administration of naldemedine (0.3 mg/kg) and alvimopan (3 mg/kg) significantly inhibited the decrease in intestinal motility induced by mechanical irritation in mice (p < 0.01, for both). Naldemedine (1 mg/kg) significantly shortened the adhesion length in chemical-induced postoperative adhesion model rats (p < 0.05). Alvimopan (3 mg/kg) also significantly reduced the adhesion ratio (p < 0.01). These findings suggest that naldemedine is effective for postoperative intestinal hypomotility and adhesions in rodents (i.e., as for alvimopan). Thus, naldemedine may be a useful option for the treatment of POI.

Quality markers of Dajianzhong decoction based on multicomponent qualitative and quantitative analysis combined with network pharmacology and chemometric analysis.

Dajianzhong decoction (DJZD), a classic famous prescription, has a long history of medicinal application. Modern studies have demonstrated its clinical utility in the treatment of postoperative ileus (POI). But none of the current quality evaluation methods for this compound is associated with efficacy. This study aimed to identify the quality markers (Q-Markers) connected to the treatment of POI in DJZD. Ultra-performance liquid chromatography quadrupole Exactive Orbitrap mass spectrometry (UPLC-Q-Exactive Orbitrap-MS) was used to identify the main constituents in DJZD. Based on the qualitative results obtained by fingerprinting, chemical pattern recognition (CPR) was used to analyse the key components affecting the quality and finally to establish the network of the active ingredients in DJZD with POI. A total of 64 chemical components were detected. After fingerprint analysis, 13 common peaks were identified. The fingerprint similarity of 15 batches of samples ranged from 0.860 to 1.000. CPR analysis was able to categorically classify 15 batches of DJZD into two groups. And gingerenone A, methyl-6-gingerdiol, 6-gingerol, and hydroxy-β-sanshool contributed to their grouping. Twelve common components interact with the therapeutic targets for treating POI. In addition, the mechanism of this prescription for treating POI may be related to the jurisdiction of the neurological system, the immunological system, and the inflammatory response. This integrated approach can accurately assess and forecast the quality of DJZD, presume the Q-Markers of DJZD for POI, and lay the foundation for studying the theoretical underpinnings and exploring the mechanism of DJZD in the treatment of POI.

Phlorizin attenuates postoperative gastric ileus in rats.

Postoperative ileus (POI) is a major complication of abdominal surgery (AS). Impaired gut barrier mediated via Toll-like receptor 4 (TLR4) and interleukin-1 (IL-1) receptor is involved in the development of POI. Phlorizin is a nonselective inhibitor of sodium-linked glucose transporters (SGLTs) and is known to improve lipopolysaccharide (LPS)-induced impaired gut barrier. This study aimed to clarify our hypothesis that AS-induced gastric ileus is mediated via TLR4 and IL-1 signaling, and phlorizin improves the ileus. AS consisted of a celiotomy and manipulation of the cecum for 1 min. Gastric emptying (GE) in 20 min with liquid meal was determined 3 h after the surgery in rats. The effect of subcutaneous (s.c.) injection of LPS (1 mg kg-1 ) was also determined 3 h postinjection. AS delayed GE, which was blocked by TAK-242, an inhibitor of TLR4 signaling and anakinra, an IL-1 receptor antagonist. LPS delayed GE, which was also mediated via TLR4 and IL-1 receptor. Phlorizin (80 mg kg-1 , s.c.) significantly improved delayed GE induced by both AS and LPS. However, intragastrical (i.g.) administration of phlorizin did not alter it. As gut mainly expresses SGLT1, SGLT2 may not be inhibited by i.g. phlorizin. The effect of phlorizin was blocked by ghrelin receptor antagonist in the LPS model. AS-induced gastric ileus is mediated via TLR4 and IL-1 signaling, which is simulated by LPS. Phlorizin improves the gastric ileus via activation of ghrelin signaling, possibly by inhibition of SGLT2. Phlorizin may be useful for the treatment of POI.

Pathogenesis, Updates on Current Treatment Options and Alvimopan for Postoperative Ileus

ABSTRACT: Postoperative Ileus (POI) is a recurrent incident following intestinal as well as other types of surgery that causes aggregation of gases and inner secretions in patients, resulting in significant costs to health care providers and morbidity. The pathophysiology of the POI is multifactorial, and treatment duration of the POI associated with the degree of surgical trauma. Exogenous opioids, neurohormonal dysfunction, fluid overload, inflammation, and gastrointestinal strain are the main pathophysiological factors underlying POI. Different treatment options currently available to reduce duration of POI. Recent studies have shown that the effective approaches in reducing patient morbidity with early return of gut functions are Enhanced Recovery After Surgery (ERAS) pathway and laparoscopic surgery. Alvimopan (ALV) is a peripherally acting antagonist of the µ opioid receptor in postoperative ileus. Alvimopan (Entereg®), the FDA-approved product for the fastest recovery of bowel (large and small) resection with primary anastomosis, shows potential advances for the treatment of POI. It has limited bioavailability through the oral route due to solubility limitations. ALV prevents binding of opioid agonists to the μ-opioid receptor and assists in stopping constipation in the GI tract; it is also not able to cross the blood-brain barrier, so it does not obstruct with centrally mediated opioid analgesia. The safety &amp; efficacy studies of Alvimopan showed that the patients who go through segmental bowel surgeries along with primary anastomosis and given ALV reduces the duration of stay and overall direct costs compared with control group. The objectives of this systematic review were to give an update of categorization systems, pathogenesis mechanisms, current treatment for established POI, and updates on Alvimopan for POI.

General anaesthesia-related complications of gut motility with a focus on cholinergic mechanisms, TRP channels and visceral pain.

General anesthesia produces multiple side effects. Notably, it temporarily impairs gastrointestinal motility following surgery and causes the so-called postoperative ileus (POI), a multifactorial and complex condition that develops secondary to neuromuscular failure and mainly affects the small intestine. There are currently limited medication options for POI, reflecting a lack of comprehensive understanding of the mechanisms involved in this complex condition. Notably, although acetylcholine is one of the major neurotransmitters initiating excitation-contraction coupling in the gut, cholinergic stimulation by prokinetic drugs is not very efficient in case of POI. Acetylcholine when released from excitatory motoneurones of the enteric nervous system binds to and activates M2 and M3 types of muscarinic receptors in smooth muscle myocytes. Downstream of these G protein-coupled receptors, muscarinic cation TRPC4 channels act as the major focal point of receptor-mediated signal integration, causing membrane depolarisation accompanied by action potential discharge and calcium influx via L-type Ca2+ channels for myocyte contraction. We have recently found that both inhalation (isoflurane) and intravenous (ketamine) anesthetics significantly inhibit this muscarinic cation current (termed mI CAT) in ileal myocytes, even when G proteins are activated directly by intracellular GTPγS, i.e., bypassing muscarinic receptors. Here we aim to summarize Transient Receptor Potential channels and calcium signalling-related aspects of the cholinergic mechanisms in the gut and visceral pain, discuss exactly how these may be negatively impacted by general anaesthetics, while proposing the receptor-operated TRPC4 channel as a novel molecular target for the treatment of POI.

Gastrointestinal pacing as a treatment of postoperative ileus following extensive surgery for peritoneal metastases - A prospective blinded randomized controlled clinical trial.

Background: Almost 10% of colorectal cancer patients present with or recur with peritoneal metastases. Currently, the only treatment with curative intent is extensive cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). More than half of patients undergoing CRS and HIPEC develop prolonged postoperative ileus (POI), defined as more than 5 days without gastrointestinal (GI) function. POI represents a major clinical challenge as it causes nausea, vomiting, stomach cramps and general discomfort for the patient. Currently no efficient treatment exists.

The Effects of Combined Gum-chewing and Parenteral Metoclopramide on the Duration of Postoperative Ileus After Abdominal Surgery.

Postoperative ileus remains the most common cause of prolonged hospital stay after abdominal surgery. Various agents have been tested in the treatment of postoperative ileus but no agent alone has achieved effectiveness as postoperative ileus is of multifactorial aetiology. The aim of this study was to assess the effects of combined use of gum-chewing and parenteral metoclopramide on the duration of postoperative ileus after abdominal surgery. This was a randomised controlled study of patients aged 16-65 years who underwent elective abdominal surgeries. Patients were randomised into a gum-metoclopramide (GM) group, a gum-only (G) group, a metoclopramide-only (M) group and a control (C) group. Patients in the GM group chewed gum and received intravenous metoclopramide, each 8 hourly. In G group, patients chewed only gum, whereas those in M group received only 10mg of intravenous metoclopramide, 8 hourly. To C group, 10 mL of intravenous sterile water was given 8 hourly. Patients were monitored for time to passage of first flatus or faeces. Groups were compared for the duration of postoperative ileus and duration of hospital stay using analysis of variance. Statistical significance was set at a P value of <0.05. Fifty-two out of the 105 recruited patients were eligible for analysis. The male-to-female ratio was 1:1.9 with a median age of 57.0 years (interquartile range [IQR] =16 years). Prolonged postoperative ileus occurred in 9.4% (n = 5) of the patients (GM = 2, G = 1, M = 2, C = 0; P = 0.604) and was associated with longer duration of nasogastric tube use (P = 0.028). The duration of postoperative ileus was 3 days (IQR = 2), 2.5 days (IQR = 3.3), 4 days (IQR = 1.5) and 3 days (IQR = 2) in the GM, G, M, and C groups, respectively (P = 0.317), whereas the median duration of hospital stay was 7 days (IQR = 3), shortest in G group (6.5 days, IQR = 8) and longest in M group (9 days, IQR = 3) (P = 0.143). The combined use of gum-chewing and parenteral metoclopramide had no effect on the duration of postoperative ileus following abdominal surgeries in adult surgical patients.

Effect of Coffee Consumption on Postoperative Ileus after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials.

Background Postoperative ileus (POI) is an important complication after elective colorectal surgery, which prolongs hospital stay and increases hospital costs. Coffee has been reported to be beneficial for the recovery of gastrointestinal function. We aimed to investigate the effectiveness of coffee consumption in the treatment of POI, following elective colorectal surgery. Methods A comprehensive literature search for medical subject heading (MeSH) terms, including coffee, caffeine, colon, rectum, and colorectal surgery was conducted in PubMed, Embase, and Cochrane Library until November 2021. A meta-analysis of postoperative outcomes was conducted to assess the effectiveness of coffee consumption on POI after colorectal surgery. Results 726 articles were identified and six RCTs that captured 416 patients were included. The time to first defecation was reduced with postoperative coffee consumption compared to the control group (mean difference = −15.03 h; 95% confidence interval: -17.79, -12.26; P < 0.00001). There was no difference in time to first flatus, time to tolerance for solid food, length of hospital stay, use of laxatives, reinsertion of nasogastric tube, need for reoperation, postoperative complications, and anastomotic leak between the groups. Coffee did not have any adverse effects. Conclusion The current literature revealed that postoperative coffee consumption shortened the time to first defecation following elective colorectal surgery. Large sample and tightly controlled multicenter randomized clinical trials are needed to offer a more accurate evaluation of the efficacy of coffee.

Electroacupuncture versus sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: study protocol for a multicentre, randomised, sham-controlled trial

IntroductionPostoperative ileus (POI) is an inevitable complication of almost all abdominal surgeries, which results in prolonged hospitalisation and increased healthcare costs. Various treatment strategies have been developed for POI but...

Purinergic P2X7 receptor antagonist ameliorates intestinal inflammation in postoperative ileus.

Postoperative ileus (POI) is a postsurgical gastrointestinal motility dysfunction caused by mechanical stress to the intestine during abdominal surgery. POI leads to nausea and vomiting reduced patient quality of life, as well as high medical costs and extended hospitalization. Intestinal inflammation caused by macrophages and neutrophils is thought to be important in the mechanism of POI. Surgery-associated tissue injury and inflammation induce the release of adenosine triphosphate (ATP) from injured cells. Released ATP binds the purinergic P2X7 receptor (P2X7R) expressed on inflammatory cells, inducing the secretion of inflammatory mediators. P2X7R antagonists are thought to be important mediators of the first step in the inflammation process, and studies in chemically induced colitis models confirmed that P2X7R antagonists exhibit anti-inflammatory effects. Therefore, we hypothesized that P2X7R plays an important role in POI. POI models were generated from C57BL/6J mice. Mice were treated with P2X7R antagonist A438079 (34 mg/kg) 30 min before and 2 hr after intestinal manipulation (IM). Inflammatory cell infiltration and gastrointestinal transit were measured. A438079 ameliorated macrophage and neutrophil infiltration in the POI model. Impaired intestinal transit improved following A438079 treatment. P2X7R was expressed on both infiltrating and resident macrophages in the inflamed ileal muscle layer. The P2X7R antagonist A438079 exhibits anti-inflammatory effects via P2X7R expressed on macrophages and therefore could be a target in the treatment of POI.

The Efficacy and Safety of Methylnaltrexone for the Treatment of Postoperative Ileus.

Postoperative ileus (POI) is a surgical complication resulting in increased morbidity and length of stay (LOS). Usual care for POI includes bowel rest and gastric decompression. It has been questioned if methylnaltrexone (MNTX), a peripheral opioid antagonist, could be used as treatment for POI. The purpose of this study was to determine if MNTX is effective and safe for POI treatment. This single-center, retrospective cohort study included patients ⩾ 18years with a POI. Patients with acute colonic pseudo-obstruction, small bowel obstruction, and gastrointestinal malignancy were excluded. The intervention was MNTX administration. The primary outcome was time to ileus resolution. Secondary outcomes included LOS, duration of nasogastric tube, total parenteral nutrition requirement, and incidence of gastrointestinal perforations. 110 patients were included in the analysis; 28 received MNTX. Time to ileus resolution was 9.9days for the MNTX group and 11.4days for the control group (P = .38). Duration of gastric decompression was 4.6days for the MNTX group and 4.2days for the control group (P = .71). Length of stay was 19.9days for the MNTX group and 19.7days for the control group (P = .96). The percentage of TPN requirement was 17.9% in the MNTX group and 22.0% in the control group (P = .65). No gastrointestinal perforations were observed in either group. For the treatment of POI, MNTX did not significantly reduce time to resolution of ileus, LOS, duration of gastric decompression, or TPN requirements. However, no gastrointestinal perforations were seen, indicating that MNTX may be safely used in these patients.

The NEAT Study (Novel ElectroAcupuncture) - Electroacupuncture After Laparoscopic Colon Cancer Resection: Thinking Outside The Box. Study Protocol.

Introduction: Colorectal cancer is the second leading cause of cancer-related death in the US; complete surgical resection is the only curative treatment for non-metastatic colorectal cancer (NMCC). Postoperative ileus (POI) frequently increases patient morbidity and healthcare costs. Enhanced recovery after surgery (ERAS) protocol is the standard of care in most institutions and has been shown to reduce postoperative complications, but there is no a completely effective treatment for this condition. Studies suggest that electroacupuncture (EA) can improve gastrointestinal tract function after surgery. Objective: We aim to determine if including EA in the standard treatment of POI decreases the time to the first defecation, enhancing the return of normal bowel function after colon resection for NMCC. Methods: We propose a phase II, single-center, randomized, triple-blinded, sham-controlled trial with two parallel arms and a 1:1 allocation ratio. Patients 40-80 years of age diagnosed with NMCC scheduled to undergo laparoscopic surgery for colon cancer resection will be included. The arms will be EA + standard treatment and sham EA + standard treatment. The standard treatment will follow the ERAS protocol. Discussion: This will be the first randomized clinical trial to evaluate the impact of using EA along with the ERAS protocol for POI. This intervention may reduce patient morbidity and improve healthcare costs associated with the disease.

Efficacy and safety of acupuncture in postoperative ileus after gynecological surgery: A protocol for system review and meta-analysis of randomized controlled trials.

Background:Acupuncture is widely used in treatment of postoperative ileus (POI), but the safety and efficacy of acupuncture in POI after gynecological surgery still lack of evidence-based basis.Methods:PubMed, CINAHL, EMBASE, Web of science, Google Scholar, Wangfang database, Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database, and China National Knowledge Infrastructure database will be searched until December 31, 2020. Two independent investigators will screen the relevant randomized controlled trials from Data one by one by using prespecified criteria. The relevant data from included studies will be extracted and analyzed by using RevMan V.5.3 software. Quality of the included studies will be estimated by using the Cochrane Collaboration risk of bias tool, and publication bias will be assessed by using Egger test and Begg test. In addition, quality of evidence will be evaluated by using Grading of Recommendations Assessment, Development, and Evaluation.Results:We will analyze the effect of acupuncture on time to first flatus and time to bowel sound recovery as the primary outcomes of this review. Meanwhile, frequency of bowel sounds, time to defecation, time of hospital stay, biochemical indicators related to gastrointestinal motility, inflammation factors, responder rate, and adverse events for patients receiving gynecological surgery.Conclusion:Our findings will benefit researchers and provide reference for the treatment and prevention of POI for the patients undergoing gynecological surgery.

Advances in the prevention and treatment of postoperative ileus

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.

Postoperative Ileus Complicated with Incomplete Evisceration after Hysterectomy for Benign Pathology.

Postoperative ileus (POI) is a complex phenomenon with important morbidity and mortality, well known in many surgical fields. POI occurs commonly after abdominal and pelvic surgery, especially in cancer patients. We report the case of a 63-year-old patient without known risk factors for POI, who underwent total hysterectomy with bilateral adnexectomy for ovarian tumor with suspicion of malignancy, invalidated by the extemporaneous pathology examination. The postoperative evolution is marked by reduced bowel movements, lack of intestinal transit for flatus and stool for 6 days. In cooperation with the general surgeon conservative treatment for POI was administered, without effect. The abdomen remained distended, with no nausea or vomiting. On the 6th postoperative day a wound dehiscence with incomplete evisceration occurred, after a CT scan of the abdomen and pelvic region was requested to make a differential diagnosis between an intestinal mass and other pathology involving the bowell. In conjunction with the General Surgery team the surgical reintervention was decided and performed. After the procedure, the patient successfully regained transit, with flatus and stool emission, but another 2 complications occurred, which were successfully treated: sepsis and deep vein thrombosis. Understanding the pathophysiology could help to prevent, diagnose, and implement protocols in order to avoid POI and its complications, to reduce hospital stay and cost burden.

Electroacupuncture or transcutaneous electroacupuncture for postoperative ileus after abdominal surgery: A systematic review and meta-analysis.

At present, there is no ideal treatment for postoperative ileus (POI) after abdominal surgery. This meta-analysis aims to evaluate the efficacy of electroacupuncture (EA) and transcutaneous electroacupuncture (TEA) in improving postoperative POI. We systematically screened randomized controlled trials (RCTs) from multiple databases and included 15 high quality RCTs. Two investigators independently conducted data extraction, risk of bias assessment and statistical analysis. Meta-analysis was performed by a random- (REM) or fixed-effect (FIXED) model. A total of 15 trials involving 965 participates were included. Meta-analysis results favored EA/TEA treatment for POI by analysis of time to first flatus [mean difference (MD) -11.60 h, I2 = 94%, REM)], time to first defecation (MD -12.94 h, I2 = 90%, REM), time to bowel sound recovery (MD -7.25 h, I2 = 85%, REM), time to first oral feeding (MD -15.76 h, I2 = 47%, REM) and length of hospital stay (MD -1.19 d, I2 = 44%, REM). Subgroup analysis of laparoscopic surgery patients also favored EA/TEA by analysis of time to first flatus (MD -2.46 h, I2 = 0%, FIXED), time to first oral feeding (MD -10.73 h, I2 = 0%, FIXED) and length of hospital stay (MD -1.30 d, I2 = 32%, REM). ST36 (Zusanli), ST37 (Shangjuxu) and ST39 (Xiajuxu) are preferred EA/TEA acupoints for treating POI. There was no significant difference in postoperative analgesic consumption between EA and control groups (P = 0.39). No severe adverse events associated with EA/TEA were reported. This meta-analysis suggests that EA/TEA is a safe, effective treatment for POI after abdominal surgeries including laparoscopic surgery, and that EA/TEA does not relieve postoperative pain after abdominal surgery. There is significant heterogeneity of research on this subject, thus, a professional consensus is needed to establish a standard protocol for use of this technique.