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Journal of Gastrointestinal Surgery

, Volume 17, Issue 5, pp 962–972 | Cite as

Defining Postoperative Ileus: Results of a Systematic Review and Global Survey

  • Ryash Vather
  • Sid Trivedi
  • Ian Bissett
Original Article

Abstract

Background

There is a lack of an internationally accepted standardised clinical definition for postoperative ileus (POI). This has made it difficult to estimate incidence and identify risk factors and has compromised external validity of clinical trials.

Aim

To clarify terminology of POI and propose concise, clinically quantifiable definitions.

Methods

A systematic review extracted definitions from randomised trials published between 1996 and 2011 investigating POI after abdominal surgery. This was followed by a global survey seeking opinions of those who have published in the field.

Results

Definitions were extracted from 52 identified trials. Responses were received in the survey from 45 of 118 corresponding authors. Data were amalgamated to synthesise the following definitions: postoperative ileus (POI) “interval from surgery until passage of flatus/stool AND tolerance of an oral diet”; prolonged POI “two or more of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, distension, radiologic confirmation occurring on or after day 4 postoperatively without prior resolution of POI”; recurrent POI “two or more of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, distension, radiologic confirmation, occurring after apparent resolution of POI”. Concordance of the latter two definitions with survey responses were ≥75 %.

Conclusion

We have proposed standardised endpoints for use in future studies to facilitate objective comparison of competing interventions.

Keywords

Postoperative ileus Definitions Abdominal surgery 

Notes

Funding

Ryash Vather is a doctoral student funded by the Royal Australasian College of Surgeons’ Foundation for Surgery Research Fellowship.

Conflict of Interest

None.

References

  1. 1.
    Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus. World Journal of Surgery. 2006;30(8):1382–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Baig MK, Wexner SD. Postoperative ileus: a review. Diseases of the Colon & Rectum. 2004;47(4):516–26.CrossRefGoogle Scholar
  3. 3.
    Goldstein JL, Matuszewski KA, Delaney C, Senagore A, Chiao E, Shah M, et al. Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States. P AND T. 2007;32(2):82.Google Scholar
  4. 4.
    Kronberg U, Kiran RP, Soliman MSM, Hammel JP, Galway U, Coffey JC, et al. A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Annals of Surgery. 2011;253(1):78–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009;6(7):e1000097.PubMedCrossRefGoogle Scholar
  6. 6.
    Finley R. Survey Monkey. com. Portland, OR. 2007.Google Scholar
  7. 7.
    Akhlaghi F, Pourjavad M, Mansouri A, Tara F, Vahedian M. Effect of gum chewing on prevention of post cesarean ileus [Farsi]. HAYAT. 2008;14(2):84-.Google Scholar
  8. 8.
    Asao T, Kuwano H, Nakamura J-i, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. Journal of the American College of Surgeons. 2002;195(1):30–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Askarpouri S, Shoushtari MHS, Saadati M. Study of the effect of early feeding, chewing gums, and laxative on ileus in patients who underwent open cholecystectomy. Internet Journal of Surgery. 2010;22(2):9p.Google Scholar
  10. 10.
    Bandeira Ferraz AA, Paraiso Wanderley GJ, Arcanjo dos Santos M, Jr., Mathias CA, Correa de Araujo JG, Jr., Machado Ferraz E. Effects of propranolol on human postoperative ileus. Dig Surg. 2001;18(4):305–10.CrossRefGoogle Scholar
  11. 11.
    Buchler MW, Seiler CM, Monson JRT, Flamant Y, Thompson-Fawcett MW, Byrne MM, et al. Clinical trial: alvimopan for the management of post-operative ileus after abdominal surgery: results of an international randomized, double-blind, multicentre, placebo-controlled clinical study. Alimentary Pharmacology & Therapeutics. 2008;28(3):312–25.CrossRefGoogle Scholar
  12. 12.
    Caliskan E, Turkoz A, Sener M, Bozdogan N, Gulcan O, Turkoz R. A prospective randomized double-blind study to determine the effect of thoracic epidural neostigmine on postoperative ileus after abdominal aortic surgery. Anesth Analg. 2008;106(3):959–64, table of contents.Google Scholar
  13. 13.
    Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Diseases of the Colon & Rectum. 2001;44(8):1083–9.CrossRefGoogle Scholar
  14. 14.
    Chen J-Y, Ko T-L, Wen Y-R, Wu S-C, Chou Y-H, Yien H-W, et al. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain. 2009;25(6):485–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen JY, Wu GJ, Mok MS, Chou YH, Sun WZ, Chen PL, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand. 2005;49(4):546–51.PubMedCrossRefGoogle Scholar
  16. 16.
    da Fonseca LM, Profeta da Luz MM, Lacerda-Filho A, Correia MITD, Gomes da Silva R. A simplified rehabilitation program for patients undergoing elective colonic surgery—randomized controlled clinical trial. International Journal of Colorectal Disease. 2011;26(5):609–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Delaney CP, Weese JL, Hyman NH, Bauer J, Techner L, Gabriel K, et al. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Diseases of the Colon & Rectum. 2005;48(6):1114–25; discussion 25–6; author reply 27–9.CrossRefGoogle Scholar
  18. 18.
    Groudine SB, Fisher HA, Kaufman RP, Jr., Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg. 1998;86(2):235–9.PubMedGoogle Scholar
  19. 19.
    Grundel K, Schwenk W, Bohm B, Muller JM. [Effect of orthograde intestinal irrigation with prepacol and polyethyleneglycol solution on duration of postoperative ileus after colorectal resections]. Langenbecks Arch Chir. 1996;381(3):160–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Han-Geurts IJM, Hop WCJ, Kok NFM, Lim A, Brouwer KJ, Jeekel J. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery. Br J Surg. 2007;94(5):555–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Harvey KP, Adair JD, Isho M, Robinson R. Can intravenous lidocaine decrease postsurgical ileus and shorten hospital stay in elective bowel surgery? A pilot study and literature review. Am J Surg. 2009;198(2):231–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Kramer RL, Van Someren JK, Qualls CR, Curet LB. Postoperative management of cesarean patients: the effect of immediate feeding on the incidence of ileus. Obstetrics & Gynecology. 1996;88(1):29–32.CrossRefGoogle Scholar
  23. 23.
    Kudoh A, Katagai H, Takazawa T. Effect of epidural analgesia on postoperative paralytic ileus in chronic schizophrenia. Reg Anesth Pain Med. 2001;26(5):456–60.PubMedGoogle Scholar
  24. 24.
    Kuo CP, Jao SW, Chen KM, Wong CS, Yeh CC, Sheen MJ, et al. Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery. British Journal of Anaesthesia. 2006;97(5):640–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Le Blanc-Louvry I, Costaglioli B, Boulon C, Leroi A-M, Ducrotte P. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. Journal of Gastrointestinal Surgery. 2002;6(1):43–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Le Blanc-Louvry I, Coquerel A, Koning E, Maillot C, Ducrotte P. Operative stress response is reduced after laparoscopic compared to open cholecystectomy: The relationship with postoperative pain and ileus. Digestive Diseases and Sciences. 2000;45(9):1703–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Lightfoot AJ, Eno M, Kreder KJ, O’Donnell MA, Rao SSC, Williams RD. Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Urology. 2007;69(4):611–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Ludwig K, Enker WE, Delaney CP, Wolff BG, Du W, Fort JG, et al. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008;143(11):1098–105.PubMedCrossRefGoogle Scholar
  29. 29.
    Massey RL. A randomized trial of rocking-chair motion on the effect of postoperative ileus duration in patients with cancer recovering from abdominal surgery. Applied Nursing Research. 2010;23(2):59–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Matros E, Rocha F, Zinner M, Wang J, Ashley S, Breen E, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial. Journal of the American College of Surgeons. 2006;202(5):773–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Narita K, Tsunoda A, Takenaka K, Watanabe M, Nakao K, Kusano M. Effect of mosapride on recovery of intestinal motility after hand-assisted laparoscopic colectomy for carcinoma. Diseases of the Colon & Rectum. 2008;51(11):1692–5.CrossRefGoogle Scholar
  32. 32.
    Neudecker J, Schwenk W, Junghans T, Pietsch S, Bohm B, Muller JM. Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg. 1999;86(10):1292–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Ngowe MN, Eyenga VC, Kengne BH, Bahebeck J, Sosso AM. Chewing gum reduces postoperative ileus after open appendectomy. Acta Chirurgica Belgica. 2010;110(2):195–9.PubMedGoogle Scholar
  34. 34.
    Patolia DS, Hilliard Jr RLM, Toy EC, Baker IB. Early feeding after cesarean: randomized trial. Obstetrics and Gynecology. 2001;98(1):113–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Popescu I, Fleshner PR, Pezzullo JC, Charlton PA, Kosutic G, Senagore AJ. The ghrelin agonist TZP-101 for management of postoperative ileus after partial colectomy: a randomized, dose-ranging, placebo-controlled clinical trial. Diseases of the Colon & Rectum. 2010;53(2):126–34.CrossRefGoogle Scholar
  36. 36.
    Quah HM, Samad A, Neathey AJ, Hay DJ, Maw A. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis. 2006;8(1):64–70.PubMedCrossRefGoogle Scholar
  37. 37.
    Schuster R, Grewal N, Greaney GC, Waxman K. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg. 2006;141(2):174–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwenk W, Bohm B, Haase O, Junghans T, Muller JM. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg. 1998;383(1):49–55.PubMedCrossRefGoogle Scholar
  39. 39.
    Shang H, Yang Y, Tong X, Zhang L, Fang A, Hong L. Gum chewing slightly enhances early recovery from postoperative ileus after cesarean section: results of a prospective, randomized, controlled trial. American Journal of Perinatology. 2010;27(5):387–91.PubMedCrossRefGoogle Scholar
  40. 40.
    Sim R, Cheong DM, Wong KS, Lee BMK, Liew QY. Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2-specific inhibitor as opioid-sparing analgesia in major colorectal surgery. Colorectal Dis. 2007;9(1):52–60.PubMedCrossRefGoogle Scholar
  41. 41.
    Smith AJ, Nissan A, Lanouette NM, Shi W, Guillem JG, Wong WD, et al. Prokinetic effect of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Diseases of the Colon & Rectum. 2000;43(3):333–7.CrossRefGoogle Scholar
  42. 42.
    Swenson BR, Gottschalk A, Wells LT, Rowlingson JC, Thompson PW, Barclay M, et al. Intravenous lidocaine is as effective as epidural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection: a randomized clinical trial. Reg Anesth Pain Med. 2010;35(4):370–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surgical Endoscopy. 2007;21(2):247–52.PubMedCrossRefGoogle Scholar
  44. 44.
    Toyomasu Y, Mochiki E, Morita H, Ogawa A, Yanai M, Ohno T, et al. Mosapride citrate improves postoperative ileus of patients with colectomy. Journal of Gastrointestinal Surgery. 2011;15(8):1361–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Viscusi ER, Goldstein S, Witkowski T, Andonakakis A, Jan R, Gabriel K, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study.[Erratum appears in Surg Endosc. 2006 Mar;20(3):537]. Surgical Endoscopy. 2006;20(1):64–70.PubMedCrossRefGoogle Scholar
  46. 46.
    Wolff BG, Michelassi F, Gerkin TM, Techner L, Gabriel K, Du W, et al. Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Annals of Surgery. 2004;240(4):728–34; discussion 34–5.PubMedGoogle Scholar
  47. 47.
    Xie Q, Zong X, Ge B, Wang S, Ji J, Ye Y, et al. Pilot postoperative ileus study of escin in cancer patients after colorectal surgery. World Journal of Surgery. 2009;33(2):348–54.PubMedCrossRefGoogle Scholar
  48. 48.
    Yu CS, Chun H-K, Stambler N, Carpenito J, Schulman S, Tzanis E, et al. Safety and efficacy of methylnaltrexone in shortening the duration of postoperative ileus following segmental colectomy: results of two randomized, placebo-controlled phase 3 trials. Diseases of the Colon & Rectum. 2011;54(5):570–8.CrossRefGoogle Scholar
  49. 49.
    Zingg U, Miskovic D, Pasternak I, Meyer P, Hamel CT, Metzger U. Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial. International Journal of Colorectal Disease. 2008;23(12):1175–83.PubMedCrossRefGoogle Scholar
  50. 50.
    Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surgical Endoscopy. 2009;23(2):276–82.PubMedCrossRefGoogle Scholar
  51. 51.
    Meng ZQ, Garcia MK, Chiang JS, Peng HT, Shi YQ, Fu J, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World Journal of Gastroenterology. 2010;16(1):104–11.PubMedCrossRefGoogle Scholar
  52. 52.
    Wattchow DA, De Fontgalland D, Bampton PA, Leach PL, McLaughlin K, Costa M. Clinical trial: the impact of cyclooxygenase inhibitors on gastrointestinal recovery after major surgery—a randomized double blind controlled trial of celecoxib or diclofenac vs. placebo. Alimentary Pharmacology & Therapeutics. 2009;30(10):987–98.CrossRefGoogle Scholar
  53. 53.
    MacMillan SL, Kammerer-Doak D, Rogers RG, Parker KM. Early feeding and the incidence of gastrointestinal symptoms after major gynecologic surgery. Obstetrics & Gynecology. 2000;96(4):604–8.CrossRefGoogle Scholar
  54. 54.
    Adamakis I, Tyritzis SI, Koutalellis G, Tokas T, Stravodimos KG, Mitropoulos D, et al. Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion. International Braz J Urol. 2011;37(1):42–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Chan DC, Liu YC, Chen CJ, Yu JC, Chu HC, Chen FC, et al. Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy. World Journal of Gastroenterology. 2005;11(31):4776–81.PubMedGoogle Scholar
  56. 56.
    Garcia MK, Skibber JM, Rodriguez-Bigas MA, Chang DZ, Feig BW, Bisanz AK, et al. Acupuncture to prevent prolonged postoperative ileus: a randomized controlled trial. Medical Acupuncture. 2008;20(2):83–8.CrossRefGoogle Scholar
  57. 57.
    Herzog T, Lemmens HP, Arlt G, Raakow R, Weimann A, Pascher A, et al. Treatment of postoperative ileus with choline citrate—results of a prospective, randomised, placebo-controlled, double-blind multicentre trial. International Journal of Colorectal Disease. 2011;26(5):645–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Wiriyakosol S, Kongdan Y, Euanorasetr C, Wacharachaisurapol N, Lertsithichai P. Randomized controlled trial of bisacodyl suppository versus placebo for postoperative ileus after elective colectomy for colon cancer. Asian J. 2007;30(3):167–72.Google Scholar
  59. 59.
    Viscusi ER, Goldstein S, Witkowski T, Andonakakis A, Jan R, Gabriel K, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surgical Endoscopy and Other Interventional Techniques. 2006;20(1):64–70.PubMedCrossRefGoogle Scholar
  60. 60.
    Phipps M, Bush JA, Buhrow D, Tittle MB, Singh D, Harcombe J, et al. Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation. Dimensions of Critical Care Nursing. 2011;30(3):164.PubMedCrossRefGoogle Scholar
  61. 61.
    Delaney C, Kehlet H, Senagore A, Bauer A, Beart R, Billingham R, et al. Clinical Consensus Update® in General Surgery, postoperative ileus: profiles, risk factors, and definitions-a framework for optimizing surgical outcomes in patients undergoing major abdominal and colorectal surgery. Clinical Consensus Update in General Surgery [Consensus statement]. 2006.Google Scholar
  62. 62.
    Traut U, Brugger L, Kunz R, Pauli-Magnus C, Haug K, Bucher H, et al. Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database of Systematic Reviews. 2009;(4)(CD004930).Google Scholar
  63. 63.
    Althausen PL, Gupta MC, Benson DR, Jones DA. The use of neostigmine to treat postoperative ileus in orthopedic spinal patients. Journal of Spinal Disorders & Techniques. 2001;14(6):541–5.CrossRefGoogle Scholar
  64. 64.
    Bederman SS, Betsy M, Winiarsky R, Seldes RM, Sharrock NE, Sculco TP. Postoperative ileus in the lower extremity arthroplasty patient. The Journal of Arthroplasty. 2001;16(8):1066–70.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of AucklandAucklandNew Zealand
  2. 2.Department of Surgery, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand

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