, Volume 62, Issue 18, pp 2603–2615

Postoperative Ileus

Progress Towards Effective Management
Review Article


The pathogenesis of postoperative ileus (PI) is multifactorial, and includes activation of inhibitory reflexes, inflammatory mediators and opioids (endogenous and exogenous). Accordingly, various strategies have been employed to prevent PI. As single-modality treatment, continuous postoperative epidural analgesia including local anaesthetics has been most effective in the prevention of PI. Choice of anaesthetic technique has no major impact on PI. Minimally invasive surgery reduces PI, in accordance with the sustained reduction in the inflammatory responses, while the effects of early institution of oral nutrition on PI per se are minor. Several pharmacological agents have been employed to resolve PI (propranolol, dihydroergotamine, neostigmine, erythromycin, cisapride, meto-clopramide, cholecystokinin, ceruletide and vasopressin), most with either limited effect or limited applicability because of adverse effects. The development of new peripheral selective opioid antagonists is promising and has been demonstrated to shorten PI significantly. A multi-modal rehabilitation programme including continuous epidural analgesia with local anaesthetics, enforced nutrition and mobilisation may reduce PI to 1–2 days after colonic surgery.


  1. 1.
    Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000; 87: 1480–93PubMedCrossRefGoogle Scholar
  2. 2.
    Kehlet H, Holte K. Review of postoperative ileus. Am J Surg 2001; 182: S3–S10Google Scholar
  3. 3.
    Chang SS, Baumgartner RG, Wells N, et al. Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol 2002; 167: 208–11PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt WK. Alvimopan* (ADL 8-2698) is a novel peripheral opioid antagonist. Am J Surg 2001; 182: S27–38CrossRefGoogle Scholar
  5. 5.
    Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630–41PubMedCrossRefGoogle Scholar
  6. 6.
    Bederman SS, Betsy M, Winiarsky R, et al. Postoperative ileus in the lower extremity arthroplasty patient. J Arthroplasty 2001; 16: 1066–70PubMedCrossRefGoogle Scholar
  7. 7.
    Livingston EH, Passaro EPJ. Postoperative ileus. Dig Dis Sci 1990; 35: 121–32PubMedCrossRefGoogle Scholar
  8. 8.
    Kalff JC, Schraut WH, Simmons RL, et al. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 1998; 228: 652–63PubMedCrossRefGoogle Scholar
  9. 9.
    Kalff JC, Carlos TM, Schraut WH, et al. Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 1999; 117: 378–87PubMedCrossRefGoogle Scholar
  10. 10.
    Kalff JC, Buchholz BM, Eskandari MK, et al. Biphasic response to gut manipulation and temporal correlation of cellular infiltrates and muscle dysfunction in rat. Surgery 1999; 126: 498–509PubMedCrossRefGoogle Scholar
  11. 11.
    Kalff JC, Schraut WH, Billiar TR, et al. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 2000; 118: 316–27PubMedCrossRefGoogle Scholar
  12. 12.
    Schwarz NT, Beer-Stolz D, Simmons RL, et al. Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis. Ann Surg 2002; 235: 31–40PubMedCrossRefGoogle Scholar
  13. 13.
    De Winter BY, Robberecht P, Boeckxstaens GE, et al. Role of VIP1/PACAP receptors in postoperative ileus in rats. Br J Pharmacol 1998; 124: 1181–6PubMedCrossRefGoogle Scholar
  14. 14.
    Espat NJ, Cheng G, Kelley MC, et al. Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 1995; 58: 719–23PubMedCrossRefGoogle Scholar
  15. 15.
    Zittel TT, Lloyd KC, Rothenhofer I, et al. Calcitonin gene-related peptide and spinal afferents partly mediate postoperative colonic ileus in the rat. Surgery 1998; 123: 518–27PubMedCrossRefGoogle Scholar
  16. 16.
    Schwarz NT, Kalff JC, Turler A, et al. Prostanoid production via COX-2 as a causative mechanism of rodent postoperative ileus. Gastroenterology 2001; 121: 1354–71PubMedCrossRefGoogle Scholar
  17. 17.
    Pappagallo M. Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg 2001; 182: S11–8CrossRefGoogle Scholar
  18. 18.
    Manara L, Bianchetti A. The central and peripheral influences of opioids on gastrointestinal propulsion. Annu Rev Pharmacol Toxicol 1985; 25: 249–73PubMedCrossRefGoogle Scholar
  19. 19.
    Manara L, Bianchi G, Ferretti P, et al. Inhibition of gastrointestinal transit by morphine in rats results primarily from direct drug action on gut opioid sites. J Pharmacol Exp Ther 1986; 237: 945–9PubMedGoogle Scholar
  20. 20.
    Culpepper-Morgan JA, Inturrisi CE, Portenoy RK, et al. Treatment of opioid-induced constipation with oral naloxone: a pilot study. Clin Pharmacol Ther 1992; 52: 90–5PubMedCrossRefGoogle Scholar
  21. 21.
    Yuan CS, Foss JF. Antagonism of gastrointestinal opioid effects. Reg Anesth Pain Med 2000; 25: 639–42PubMedGoogle Scholar
  22. 22.
    Brix-Christensen V, Goumon Y, Tonnesen E, et al. Endogenous morphine is produced in response to cardiopulmonary bypass in neonatal pigs. Acta Anaesthesiol Scand 2000; 44: 1204–8PubMedCrossRefGoogle Scholar
  23. 23.
    Brix-Christensen V, Tonnesen E, Sanchez RG, et al. Endogenous morphine levels increase following cardiac surgery as part of the antiinflammatory response? Int J Cardiol 1997; 62: 191–7PubMedCrossRefGoogle Scholar
  24. 24.
    Yoshida S, Ohta J, Yamasaki K, et al. Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopoic or open cholecystectomy. Surg Endosc 2000; 14: 137–40PubMedGoogle Scholar
  25. 25.
    Kehlet H. Endogenous morphine —another component and biological modifier of the response to surgical injury? Acta Anaesthesiol Scand 2000; 44: 1167–8CrossRefGoogle Scholar
  26. 26.
    Wilmore DW, Smith RJ, O’Dwyer ST. The gut — a central organ following surgical stress. Surgery 2000; 104: 917–23Google Scholar
  27. 27.
    Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. In pressGoogle Scholar
  28. 28.
    Kehlet H. Modification of responses to surgery by neural blockade: clinical implications. In: Cousins MJ, Bridenbaugh PS, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia (PA): Lippincott-Raven 1998, 129–75Google Scholar
  29. 29.
    Kehlet H, Werner M, Perkins F. Balanced analgesia: what is it and what are its advantages in postoperative pain? Drugs 1999; 58: 793–7PubMedCrossRefGoogle Scholar
  30. 30.
    Jorgensen H, Wetterslev J, Moiniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update SoftwareGoogle Scholar
  31. 31.
    Hodgson PS, Liu S. Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Baillieres Clin Anaesthesiol 1999; 13: 9–22Google Scholar
  32. 32.
    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. Dis Colon Rectum 2001; 44: 1083–9PubMedCrossRefGoogle Scholar
  33. 33.
    Jorgensen H, Fomsgaard JS, Dirks J, et al. Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Br J Anaesth 2001; 87: 577–83PubMedCrossRefGoogle Scholar
  34. 34.
    Finucane BT, Ganapathy S, Carli F, et al. Prolonged epidural infusions of ropivacaine (2 mg/mL) after colonic surgery: the impact of adding fentanyl. Anesth Analg 2001; 92: 1276–85PubMedCrossRefGoogle Scholar
  35. 35.
    Jorgensen H, Fomsgaard JS, Dirks J, et al. Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery. Br J Anaesth 2001; 87: 727–32PubMedCrossRefGoogle Scholar
  36. 36.
    Steinbrook RA. Epidural anesthesia and gastrointestinal motility. Anesth Analg 1998; 86: 837–44PubMedGoogle Scholar
  37. 37.
    Norris EJ, Beattie C, Perler BA, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001; 95: 1054–67PubMedCrossRefGoogle Scholar
  38. 38.
    Paulsen EK, Porter MG, Helmer SD, et al. Thoracic epidural versus patient-controlled analgesia in elective bowel resections. Am J Surg 2001; 182: 570–7PubMedCrossRefGoogle Scholar
  39. 39.
    Werner MU, Basse L, Gaarn-Larsen L, et al. Does postoperative pain influence gastro-intestinal recovery and hospital stay following colonic resection in an accelerated multimodal program? [abstract]. Anesthesiology 2001; 95: A–821Google Scholar
  40. 40.
    Holte K, Kehlet H. Epidural analgesia and risk of anastomotic leakage. Reg Anesth Pain Med 2001; 26: 111–7PubMedGoogle Scholar
  41. 41.
    Power I, Barratt S. Analgesic agents for the postoperative period. Nonopioids. Surg Clin North Am 1999; 79: 275–95CrossRefGoogle Scholar
  42. 42.
    Kelley MC, Hocking MP, Marchand SD, et al. Ketorolac prevents postoperative small intestinal ileus in rats. Am J Surg 1993; 165: 107–11PubMedCrossRefGoogle Scholar
  43. 43.
    De Winter BY, Boeckxstaens GE, De Man JG, et al. Differential effect of indomethacin and ketorolac on postoperative ileus in rats. Eur J Pharmacol 1998; 344: 71–6PubMedCrossRefGoogle Scholar
  44. 44.
    Cali RL, Meade PG, Swanson MS, et al. Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum 2000; 43: 163–8PubMedCrossRefGoogle Scholar
  45. 45.
    Foss JF. A review of the potential role of methylnaltrexone in opioid bowel dysfunction. Am J Surg 2001; 182: S19–26CrossRefGoogle Scholar
  46. 46.
    Taguchi A, Sharma N, Saleem RM, et al. Selective postoperative inhibition of gastrointestinal opioid receptors. N Engl J Med 2001; 345: 935–40PubMedCrossRefGoogle Scholar
  47. 47.
    Steinbrook RA. An opioid antagonist for postoperative ileus. N Engl J Med 2001; 345: 988–9PubMedCrossRefGoogle Scholar
  48. 48.
    Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62–72PubMedCrossRefGoogle Scholar
  49. 49.
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78: 606–17PubMedCrossRefGoogle Scholar
  50. 50.
    Hallerback B, Carlsen E, Carlsson K, et al. Beta-adrenoceptor blockade in the treatment of postoperative adynamic ileus. Scand J Gastroenterol 1987; 22: 149–55PubMedCrossRefGoogle Scholar
  51. 51.
    Hallerback B, Ander S, Glise H. Effect of combined blockade of beta-adrenoceptors and acetylcholinesterase in the treatment of postoperative ileus after cholecystectomy. Scand J Gastroenterol 1987; 22: 420–4PubMedCrossRefGoogle Scholar
  52. 52.
    Ferraz AA, Wanderley GJ, Santos Jr MA, et al. Effects of propranolol on human postoperative ileus. Dig Surg 2001; 18: 305–10PubMedCrossRefGoogle Scholar
  53. 53.
    Altaparmakov I, Erckenbrecht JF, Wienbeck M. Modulation of the adrenergic system in the treatment of postoperative bowel atonia. Scand J Gastroenterol 1984; 19: 1104–6PubMedGoogle Scholar
  54. 54.
    Thorup J, Wille-Jorgensen P, Jorgensen T, et al. Dihydroergotamine in postoperative ileus. Clin Pharmacol Ther 1983; 34: 54–5PubMedCrossRefGoogle Scholar
  55. 55.
    Kreis ME, Kasparek M, Zittel TT, et al. Neostigmine increases postoperative colonic motility in patients undergoing colorectal surgery. Surgery 2001; 130: 449–56PubMedCrossRefGoogle Scholar
  56. 56.
    Myrhoj T, Olsen O, Wengel B. Neostigmine in postoperative intestinal paralysis. A double-blind, clinical, controlled trial. Dis Colon Rectum 1988; 31: 378–9Google Scholar
  57. 57.
    Smith AJ, Nissan A, Lanouette NM, et al. Prokinetic effect of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Dis Colon Rectum 2000; 43: 333–7PubMedCrossRefGoogle Scholar
  58. 58.
    Bonacini M, Quiason S, Reynolds M, et al. Effect of intravenous erythromycin on postoperative ileus. Am J Gastroenterol 1993; 88: 208–11PubMedGoogle Scholar
  59. 59.
    Tollesson PO, Cassuto J, Rimback G, et al. Treatment of postoperative paralytic ileus with cisapride. Scand J Gastroenterol 1991; 26: 477–82PubMedCrossRefGoogle Scholar
  60. 60.
    Brown TA, McDonald J, Williard W. A prospective, randomized, double-blinded, placebo-controlled trial of cisapride after colorectal surgery. Am J Surg 1999; 177: 399–401PubMedCrossRefGoogle Scholar
  61. 61.
    Boghaert A, Haesaert G, Mourisse P, et al. Placebo-controlled trial of cisapride in postoperative ileus. Acta Anaesthesiol Belg 1987; 38: 195–9PubMedGoogle Scholar
  62. 62.
    Verlinden M, Michiels G, Boghaert A, et al. Treatment of postoperative gastrointestinal atony. Br J Surg 1987; 74: 614–7PubMedCrossRefGoogle Scholar
  63. 63.
    Hallerback H, Bergman B, Bing H. Cisapride in the treatment of postoperative ileus. Aliment Pharmacol Ther 1991; 5: 503–11PubMedCrossRefGoogle Scholar
  64. 64.
    Benson MJ, Roberts JP, Wingate DL, et al. Small bowel motility following major intra-abdominal surgery: the effects of opiates and rectal cisapride. Gastroenterology 1994; 106: 924–36PubMedGoogle Scholar
  65. 65.
    Roberts JP, Benson MJ, Rogers J, et al. Effect of cisapride on distal colonic motility in the early postoperative period following left colonic anastomosis. Dis Colon Rectum 1995; 38: 139–45PubMedCrossRefGoogle Scholar
  66. 66.
    von Ritter C, Hunter S, Hinder RA. Cisapride does not reduce postoperative paralytic ileus. S Afr J Surg 1987; 25: 19–21Google Scholar
  67. 67.
    Cheape JD, Wexner SD, James K, et al. Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial. Dis Colon Rectum 1991; 34: 437–41PubMedCrossRefGoogle Scholar
  68. 68.
    Tollesson PO, Cassuto J, Faxen A, et al. Lack of effect of metoclopramide on colonic motility after cholecystectomy. Eur J Surg 1991; 157: 355–8PubMedGoogle Scholar
  69. 69.
    Davidson ED, Hersh T, Brinner RA, et al. The effects of metoclopramide on postoperative ileus. A randomized double-blind study. Ann Surg 1979; 190: 27–30Google Scholar
  70. 70.
    Jepsen S, Klaerke A, Nielsen PH, et al. Negative effect of metoclopramide in postoperative adynamic ileus. A prospective, randomized, double blind study. Br J Surg 1986; 73: 290–1Google Scholar
  71. 71.
    Frisell J, Magnusson I, Leijonmarck CE, et al. The effect of cholecystokinin on postoperative bowel function. Acta Chir Scand 1985; 151: 557–9PubMedGoogle Scholar
  72. 72.
    Sadek SA, Cranford C, Eriksen C, et al. Pharmacological manipulation of adynamic ileus: controlled randomized double-blind study of ceruletide on intestinal motor activity after elective abdominal surgery. Aliment Pharmacol Ther 1988; 2: 47–54PubMedCrossRefGoogle Scholar
  73. 73.
    Madsen PV, Lykkegaard-Nielsen M, Nielsen OV. Ceruletide reduces postoperative intestinal paralysis. A double-blind placebo-controlled trial. Dis Colon Rectum 1983; 26: 159–60Google Scholar
  74. 74.
    Hakansson T, Watt-Boolsen S, Olsen O, et al. Postoperative intestinal atony and vasopressin. A randomized study of the effect of administration of vasopressin on the duration of postoperative intestinal atony. Ugeskr Laeger 1985; 147: 3069–70Google Scholar
  75. 75.
    Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 1999; 341: 137–41PubMedCrossRefGoogle Scholar
  76. 76.
    Condon RE, Cowles VE, Ferraz AA, et al. Human colonic smooth muscle electrical activity during and after recovery from postoperative ileus. Am J Physiol 1995; 269: G408–17PubMedGoogle Scholar
  77. 77.
    Cullen JJ, Eagon JC, Kelly KA. Gastrointestinal peptide hormones during postoperative ileus. Effect of octreotide. Dig Dis Sci 1994; 39: 1179–84CrossRefGoogle Scholar
  78. 78.
    Tonini M, De Ponti F, Di Nucci A, et al. Review article: cardiac adverse effects of gastrointestinal prokinetics. Aliment Pharmacol Ther 1999; 13: 1585–91PubMedCrossRefGoogle Scholar
  79. 79.
    De Winter BY, Boeckxstaens GE, De Man JG, et al. Effect of different prokinetic agents and a novel enterokinetic agent on postoperative ileus in rats. Gut 1999; 45: 713–8PubMedCrossRefGoogle Scholar
  80. 80.
    Bungard TJ, Kale-Pradhan PB. Prokinetic agents for the treatment of postoperative ileus in adults: a review of the literature. Pharmacotherapy 1999; 19: 416–23PubMedCrossRefGoogle Scholar
  81. 81.
    Kivalo I, Miettinen K. The effects of metoclopramide on postoperative nausea and bowel function. Ann Chir Gynaecol Fenn 1970; 59: 155–8PubMedGoogle Scholar
  82. 82.
    Breivik H, Lind B. Anti-emetic and propulsive peristaltic properties of metoclopramide. Br J Anaesth 1971; 43: 400–3PubMedCrossRefGoogle Scholar
  83. 83.
    Olsen O, Hakansson T, Forrest JI. Bisocadyl in the treatment of postoperative intestinal atony. Ugeskr Laeger 1985; 147: 3070–1PubMedGoogle Scholar
  84. 84.
    Kraus K, Fanning J. Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol 2000; 182: 996–8PubMedCrossRefGoogle Scholar
  85. 85.
    Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999; 73: 412–4PubMedCrossRefGoogle Scholar
  86. 86.
    Woods JH, Erickson LW, Condon RE, et al. Postoperative ileus: a colonic problem? Surgery 1978; 84: 527–33PubMedGoogle Scholar
  87. 87.
    Kehlet H. Surgical stress response: does endoscopie surgery confer an advantage? World J Surg 1999; 23: 801–7PubMedCrossRefGoogle Scholar
  88. 88.
    Lacy AM, Garcia-Valdecasas JC, Pique JM, et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 1995; 9: 1101–5PubMedGoogle Scholar
  89. 89.
    Schwenk W, Bohm B, Haase O, et al. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 1998; 383: 49–55PubMedCrossRefGoogle Scholar
  90. 90.
    Milsom JW, Bohm B, Hammerhofer KA, et al. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998; 187: 46–54PubMedCrossRefGoogle Scholar
  91. 91.
    Leung KL, Lai PB, Ho RL, et al. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 2000; 231: 506–11PubMedCrossRefGoogle Scholar
  92. 92.
    Maxwell-Armstrong CA, Robinson MH, Scholefield JH. Laparoscopic colorectal cancer surgery. Am J Surg 2000; 179: 500–7PubMedCrossRefGoogle Scholar
  93. 93.
    Sagar PM, Kruegener G, MacFie J. Nasogastric intubation and elective abdominal surgery. Br J Surg 1992; 79: 1127–31PubMedCrossRefGoogle Scholar
  94. 94.
    Cheatham ML, Chapman WC, Key SP, et al. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995; 221: 469–76PubMedCrossRefGoogle Scholar
  95. 95.
    Sculati O, Bardi M, Radrizzani D, et al. Preoperative fibre and postoperative ileus. Lancet 1980; 1: 1252–3PubMedCrossRefGoogle Scholar
  96. 96.
    Cook JA, Fraser IA, Sandhu D, et al. A randomised comparison of two postoperative fluid regimens. Ann R Coll Surg Engl 1989; 71: 67–9PubMedGoogle Scholar
  97. 97.
    Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359: 1812–8PubMedCrossRefGoogle Scholar
  98. 98.
    Woods MS, Kelley H. Oncotic pressure, albumin and ileus: the effect of albumin replacement on postoperative ileus. Am Surg 1993; 59: 758–63PubMedGoogle Scholar
  99. 99.
    Barker P, Allcutt D, McCollum CN. Pulsed electromagnetic energy fails to prevent postoperative ileus. J R Coll Surg Edinb 1984; 29: 147–50PubMedGoogle Scholar
  100. 100.
    Tusek DL, Church JM, Strong SA, et al. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum 1997; 40: 172–8PubMedCrossRefGoogle Scholar
  101. 101.
    Disbrow EA, Bennett HL, Owings JT. Effect of preoperative suggestion on postoperative gastrointestinal motility. West J Med 1993; 158: 488–92PubMedGoogle Scholar
  102. 102.
    Le Blanc-Louvry I, Costaglioli B, Boulon C, et al. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 2002; 6: 43–9PubMedCrossRefGoogle Scholar
  103. 103.
    Basse L, Hjort Jakobsen D, Billesbolle P, et al. Accelerated rehabilitation after colon resection. Ugeskr Laeger 2001; 163: 913–7PubMedGoogle Scholar
  104. 104.
    Basse L, Hjort Jakobsen D, Billesbolle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 232: 51–7PubMedCrossRefGoogle Scholar
  105. 105.
    Basse L, Billesbolle P, Kehlet H. Early recovery after abdominal rectopexy with multimodal rehabilitation. Dis Colon Rectum 2002; 45: 195–9PubMedCrossRefGoogle Scholar
  106. 106.
    Basse L, Madsen L, Kehlet H. Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative. Br J Surg 2001; 88: 1498–500PubMedCrossRefGoogle Scholar
  107. 107.
    Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 2000; 87: 1540–5PubMedCrossRefGoogle Scholar
  108. 108.
    Senagore AJ, Whalley D, Delaney CP, et al. Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology. Surgery 2001; 129: 672–6PubMedCrossRefGoogle Scholar
  109. 109.
    Delaney CP, Fazio VW, Senagore AJ, et al. ‘Fast track’ postoperative management protocol for patients with high comorbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001; 88: 1533–8PubMedCrossRefGoogle Scholar
  110. 110.
    Brodner G, Van Aken H, Hertle L, et al. Multimodal perioperative management-combining thoracic epidural analgesia, forced mobilization, and oral nutrition-reduces hormonal and metabolic stress and improves convalescence after major urologie surgery. Anesth Analg 2001; 92: 1594–600PubMedCrossRefGoogle Scholar
  111. 111.
    Brodner G, Pogatzki E, Van Aken H, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg 1998; 86: 228–34PubMedGoogle Scholar
  112. 112.
    Lewis SJ, Egger M, Sylvester PA, et al. Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323: 773–6PubMedCrossRefGoogle Scholar

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© Adis Internotionol Limited 2002

Authors and Affiliations

  1. 1.Department of Surgical GastroenterologyHvidovre University HospitalHvidovreDenmark

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