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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank the participating experts listed in Table 3 for their time, commitment, and valuable input to this study.

Author contributions

Study conception and design: D Hahnloser, O Gié, M Hubner, D Gero

Acquisition of data: D Gero, O Gié

Analysis and interpretation of data: D Gero, O Gié, M Hübner, D Hahnloser

Drafting of manuscript: D Gero, D Hahnloser

Critical revision of manuscript: O Gié, M Hübner, N Demartines, D Hahnloser

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Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Daniel Gero, Olivier Gié, Martin Hübner, Nicolas Demartines & Dieter Hahnloser

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  1. Daniel Gero
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  2. Olivier Gié
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  3. Martin Hübner
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  4. Nicolas Demartines
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  5. Dieter Hahnloser
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Corresponding author

Correspondence to Dieter Hahnloser.

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Funding

No external sources involved.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Presented as oral communication: 102th Annual Congress of the Swiss Society of Surgery, 20–22 May 2015, Bern, Switzerland

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Gero, D., Gié, O., Hübner, M. et al. Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbecks Arch Surg 402, 149–158 (2017). https://doi.org/10.1007/s00423-016-1485-1

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  • DOI: https://doi.org/10.1007/s00423-016-1485-1

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