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Review of the Pathophysiology and Management of Postoperative Ileus

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Abstract

Investigations in the pathophysiology and treatment of postoperative ileus continue to evolve. Bowel rest is no longer a mandatory component of postoperative recovery. Tolerance of enteral nutrition and normalization of the abdominal examination are more accurate indications of the resolution of postoperative ileus than passage of flatus or first bowel movement. A multimodal "fast track" recovery approach incorporated into a clinical pathway provides a more rapid return of intestinal function and shortened hospital stay in patients undergoing major, uncomplicated gastrointestinal surgery.

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References

  1. Ballantyne GH. The meaning of ileus. Its changing definition over three millennia. Am J Surg 1984;148(2):252–256

    Article  PubMed  CAS  Google Scholar 

  2. Mythen MG. Postoperative gastrointestinal tract dysfunction. Anesth Analg 2005;100(1):196–204

    Article  PubMed  Google Scholar 

  3. Sajja SBS, Schein M. Early postoperative small bowel obstruction. Br J Surg 2004;91:683–691

    Article  PubMed  CAS  Google Scholar 

  4. Livingston EH, Passaro EP Jr. Postoperative ileus. Dig Dis Sci 1990;35(1):121–132

    Article  PubMed  CAS  Google Scholar 

  5. Luckey A, Livingston E, Tache Y. Mechanisms and treatment of postoperative ileus. Arch Surg 2003;138(2):206–214

    Article  PubMed  Google Scholar 

  6. Bauer AJ, Boeckxstaens GE. Mechanisms of postoperative ileus. Neurogastroenterol Motil 2004;16(Suppl 2):54–60

    Article  PubMed  Google Scholar 

  7. Cullen JJ, Eagon JC, Kelly KA. Gastrointestinal peptide hormones during postoperative ileus. Effect of octreotide. Dig Dis Sci 1994;39(6):1179–1184

    Article  CAS  Google Scholar 

  8. Espat NJ, Cheng G, Kelley MC, et al. Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 1995;58(6):719–723

    Article  PubMed  CAS  Google Scholar 

  9. Bult H, Boeckxstaens GE, Pelckmans PA, et al. Nitric oxide as an inhibitory non-adrenergic non-cholinergic neurotransmitter. Nature 1990;345(6273):346–347

    Article  PubMed  CAS  Google Scholar 

  10. 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(2):316–327

    Article  PubMed  CAS  Google Scholar 

  11. Kehlet H, Holte K. Review of postoperative ileus. Am J Surg 2001;182(5A Suppl):3S–10S

    Article  PubMed  CAS  Google Scholar 

  12. Schuster TG, Montie JE. Postoperative ileus after abdominal surgery. Urology 2002;59(4):465–471

    Article  PubMed  Google Scholar 

  13. Ferraz AA, Cowles VE, Condon RE, et al. Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg 1995;61(12):1079–1083

    PubMed  CAS  Google Scholar 

  14. Miedema BW, Johnson JO. Methods for decreasing postoperative gut dysmotility. Lancet Oncol 2003;4(6):365–372

    Article  PubMed  Google Scholar 

  15. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003;362(9399):1921–1928

    Article  PubMed  Google Scholar 

  16. Taguchi A, Sharma N, Saleem RM, et al. Selective postoperative inhibition of gastrointestinal opioid receptors. N Eng J Med 2001;345(13):935–940

    Article  CAS  Google Scholar 

  17. Kehlet H, Williamson R, Buchler MW, et al. A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus. Colorectal Dis 2005;7(3):245–250

    Article  PubMed  CAS  Google Scholar 

  18. Kehlet H, Buchler MW, Beart RW Jr, et al. Care after colonic operation-is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202(1):45–54

    Article  PubMed  Google Scholar 

  19. Mangesi L, Hofmeyr GJ. Early compared with delayed oral fluids and food after caesarean section. Cochrane Database Syst Rev 2002;(3):CD003516

  20. Johnson Casto C, Krammer J, Drake J. Postoperative feeding: a clinical review. Obstet Gynecol Surv 2000;55(9):571–573

    Article  PubMed  CAS  Google Scholar 

  21. Sands DR, Wexner SD. Nasogastric tubes and dietary advancement after laparoscopic and open colorectal surgery. Nutrition 1999;15(5):347–350

    Article  PubMed  CAS  Google Scholar 

  22. Park HK, Kwak C, Byun SS, et al. Early removal of nasogastric tube after cystectomy with urinary diversion: does postoperative ileus risk increase? Urology 2005;65(5):905–908

    Article  PubMed  Google Scholar 

  23. Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92(6):673–680

    Article  PubMed  CAS  Google Scholar 

  24. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2005;25(1):CD004929

    Google Scholar 

  25. Cheatham ML, Chapman WC, Key SP, et al. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995;221(5):469–476

    PubMed  CAS  Google Scholar 

  26. Waldhausen JH, Schirmer BD. The effect of ambulation on recovery from postoperative ileus. Ann Surg 1990;212(6):671–677

    PubMed  CAS  Google Scholar 

  27. Asao T, Kuwano H, Nakamura J, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002;195(1):30–32

    Article  PubMed  Google Scholar 

  28. Holte K, Kehlet H. Postoperative ileus: progress towards effective management. Drugs 2002;62(18):2603–2615

    Article  PubMed  CAS  Google Scholar 

  29. Fox VJ, Miller J, McClung M. Nutritional support in the critically injured. Crit Care Nurs Clin North Am 2004;16(4):559–569

    Article  PubMed  Google Scholar 

  30. Yanagawa T, Bunn F, Roberts I, et al. Nutritional support for head-injured patients. Cochrane Database Syst Rev 2000;(2):CD001530

  31. Delaney CP. Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterol Motil 2004;16(Suppl 2):61–66

    Article  PubMed  Google Scholar 

  32. Kelley MC, Hocking MP, Marchand SD, et al. Ketorolac prevents postoperative small intestinal ileus in rats. Am J Surg 1993;165(1):107–111

    PubMed  CAS  Google Scholar 

  33. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 2005;241(3):416–423

    Article  PubMed  Google Scholar 

  34. 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(9320):1812–1818

    Article  PubMed  Google Scholar 

  35. Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000;87(11):1480–1493

    Article  PubMed  CAS  Google Scholar 

  36. Foss JF, O’Connor MF, Yuan CS, et al. Safety and tolerance of methylnaltrexone in healthy humans: a randomized, placebo-controlled, intravenous, ascending-dose, pharmacokinetic study. J Clin Pharmacol 1997;37(1):25–30

    PubMed  CAS  Google Scholar 

  37. Delaney CP, Weese JL, Hyman NH, et al. Alvimopan postoperative ileus study group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum 2005;48(6):1114–1125

    Article  PubMed  Google Scholar 

  38. Wolff BG, Michelassi F, Gerkin TM, et al. Alvimopan postoperative ileus study group: 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. Ann Surg 2004;240(4):728–734

    PubMed  Google Scholar 

  39. De Winter BY, Boeckxstaens GE, De Man JG, et al. Effects of mu- and kappa-opioid receptors on postoperative ileus in rats. Eur J Pharmacol 1997;339(1):63–67

    Article  PubMed  Google Scholar 

  40. Bungard TJ, Kale-Pradhan PB. Prokinetic agents for the treatment of postoperative ileus in adults: a review of the literature. Pharmacotherapy 1999;19(4):416–423

    Article  PubMed  CAS  Google Scholar 

  41. 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(6):437–441

    Article  PubMed  CAS  Google Scholar 

  42. Seta ML, Kale-Pradhan PB. Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Pharmacotherapy 2001;21(10):1181–1186

    Article  PubMed  CAS  Google Scholar 

  43. Bonacini M, Quiason S, Reynolds M, et al. Effect of intravenous erythromycin on postoperative ileus. Am J Gastroenterol 1993;88(2):208–211

    PubMed  CAS  Google Scholar 

  44. 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(3):333–337

    Article  PubMed  CAS  Google Scholar 

  45. Vincent ME, Wetzner SM, Robbins AH. Pharmacology, clinical uses, and adverse effects of ceruletide, a cholecystokinetic agent. Pharmacotherapy 1982;2(4):223–234

    PubMed  CAS  Google Scholar 

  46. 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(1):47–54

    Article  PubMed  CAS  Google Scholar 

  47. Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999;73(3):412–414

    Article  PubMed  CAS  Google Scholar 

  48. Basse L, Hjort Jakobsen D, Billesbolle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232(1):51–57

    Article  PubMed  CAS  Google Scholar 

  49. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183(6):630–641

    Article  PubMed  Google Scholar 

  50. Basse L, Raskov HH, Hjort Jakobsen D, et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 2002;89(4):446–453

    Article  PubMed  CAS  Google Scholar 

  51. Delaney CP, Fazio VW, Senagore AJ, et al. ‚Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001;88(11):1533–1538

    Article  PubMed  CAS  Google Scholar 

  52. Basse L, Thorbol JE, Lossl K, et al. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004;47(3):271–277

    Article  PubMed  Google Scholar 

  53. Senagore AJ, Delaney CP, Mekhail N, et al. Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg 2003;90(10):1195–1199

    Article  PubMed  CAS  Google Scholar 

  54. Zutshi M, Delaney CP, Senagore AJ, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189(3):268–272

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Thoracic and Fetal Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Peter Mattei MD

  2. Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    John L. Rombeau MD

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  1. Peter Mattei MD
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  2. John L. Rombeau MD
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Correspondence to John L. Rombeau MD.

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Mattei, P., Rombeau, J.L. Review of the Pathophysiology and Management of Postoperative Ileus. World J. Surg. 30, 1382–1391 (2006). https://doi.org/10.1007/s00268-005-0613-9

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  • DOI: https://doi.org/10.1007/s00268-005-0613-9

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