Postoperative ileus (POI) remains an inevitable consequence of abdominal surgery. Although the pathogenesis of delayed gastrointestinal transit in the postoperative period has been the subject of considerable study, a clinically useful definition of what constitutes a pathologically prolonged ileus has yet to be established. The objectives of this study were to describe a definition for an abnormally prolonged ileus and to identify risk factors and predictors of prolonged ileus in patients undergoing abdominal surgery.
Materials and methods
Over a 12-month period 88 patients who had abdominal surgery were retrospectively reviewed. The association of clinical factors with the duration of POI was examined with statistical tests.
The mean time to commencing the consumption of unrestricted clear fluids after surgery was 2.3 ± SD 1.6 days. The median duration of POI was 5 days (median 6 days), with an interquartile range of 3–6 days. Univariate regression analysis demonstrated significant correlations between duration of POI and estimated blood loss (EBL), total surgical time, and total opiate dose (TOD) (p = 0.009, p = 0.045, and p = 0.041, respectively). Multiple regression analysis identified EBL and TOD as independent predictors of duration of POI.
We have identified two risk factors (EBL and TOD) that are independently associated with duration of POI. Our data suggest that with the definition of abnormal prolonged postoperative ileus as the number of days above the 3rd quartile, an ileus greater than 6 days serves as a better clinical definition of prolonged POI than 3 days, the measure that has previously been suggested.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87:1480–1493
Woods MS (2000) Postoperative ileus: dogma versus data from bench to bedside. Perspect Colon Rectal Surg 12:57–76
Moss G, Regal ME, Lichtig L (1986) Reducing postoperative pain, narcotics, and length of hospitalization. Surgery 99:206–210
Livingston EH, Passaro EP (1990) Postoperative ileus. Dig Dis Sci 35:121–132
Foley KM (1985) The treatment of cancer pain. N Engl J Med 313:84–95
Schang JC, Hemond M, Hebert M et al (1986) How does morphine work on colonic motility? An electromyographic study in the human left and sigmoid colon. Life Sci 38:671–676
Thorn SE, Wattwil M, Lindberg G et al (1996) Systemic and central effects of morphine on gastroduodenal motility. Acta Anaesthesiol Scand 40:177–186
Hughes J, Kosterlitz HW, Smith TW (1977) The distribution of methionine-enkephalin and leucine-enkephalin in the brain and peripheral tissues. Br J Pharmacol 61:639–647
Manara L, Bianchetti A (1985) The central and peripheral influences of opioids on gastrointestinal propulsion. Annu Rev Pharmacol Toxicol 25:249–273
Frantzides CT, Condon RE, Schulte WJ et al (1990) Effects of morphine on colonic myoelectric and motor activity in subhuman primates. Am J Physiol 258:247–252
Carli F, Trudel JL, Belliveau P (2001) The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon Rectum 44:1083–1089
Zugel N, Bruer C, Breitschaft K et al (2000) Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract. Chirurg 73:262–268
Liu SS, Carpenter RL, Mackey DC et al (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83:757–765
Fotiadis RJ, Badvie S, Weston MD et al (2004) Epidural analgesia in gastrointestinal surgery. Br J Surg 91:828–841
Fasano M, Waldvogel HH, Muller CA (1979) Prevention of paralytic ileus after colonic surgery by continuous peridural sympathetic block. Helv Chir Acta 46:245–248
Riwar A, Schar B, Grotzinger U (1992) Effect of continuous postoperative analgesia with peridural bupivacaine intestinal motility following colorectal resection. Helv Acta 58:729–733
Ahn H, Bronge A, Johansson K et al (1988) Effect of continuous postoperative epidural analgesia intestinal motility. Br J Surgery 75:1176–1178
Yuan CS, Foss JF, O’Connor M et al (1996) Methylnaltrexone prevents morphine-induced delay in oral-cecal transit time without affecting analgesia: a double-blind randomized placebo-controlled trial. Clin Pharmacol Ther 59:469–475
Taguchi A, Sharma N, Saleem RM et al (2001) Selective postoperative inhibition of gastrointestinal opioid receptors. N Engl J Med 345:935–940
Schwarz NT, Kalff JC, Turler A et al (2001) Prostanoid production via COX-2 as a causative mechanism of rodent postoperative ileus. Gastroenterology 121:1354–1371
Josephs MD, Cheng G, Ksontini R et al (1999) Products of cyclooxygenase-2 catalysis regulate postoperative bowel motility. J Surg Res 86:50–54
Turler A, Moore BA, Pezzone MA et al (2002) Colonic postoperative inflammatory ileus in the rat. Ann Surg 236:56–66
Rights and permissions
About this article
Cite this article
Artinyan, A., Nunoo-Mensah, J.W., Balasubramaniam, S. et al. Prolonged Postoperative Ileus—Definition, Risk Factors, and Predictors after Surgery. World J Surg 32, 1495–1500 (2008). https://doi.org/10.1007/s00268-008-9491-2
- Estimate Blood Loss
- Postoperative Ileus
- Opioid Medication