Prevention of postoperative ileus

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Practice Guidelines

Background:

• Postoperative ileus (PI) significantly increases patient morbidity and recovery time following major surgery.
• The complex pathophysiology of PI involves surgical stress responses, sympathetic nervous system activity, and inflammatory processes.

Purpose of the Study:

• To review and update evidence on the most effective strategies for preventing and treating postoperative ileus.
• To identify key interventions that can mitigate the incidence and duration of PI.

Main Methods:

• Systematic review of current evidence on PI prevention and treatment.
• Analysis of single interventions and multi-modal approaches.

Main Results:

• Continuous thoracic epidural analgesia with local anesthetics and minimally invasive surgery are highly effective single interventions for PI reduction.
• Pharmacological agents have shown limited success, with notable exceptions like cisapride and peripherally acting m-opioid antagonists.
• A multi-modal rehabilitation program, combining epidural analgesia, early feeding, and mobilization, is the most effective technique for PI in abdominal surgery.

Conclusions:

• Multi-modal rehabilitation programs represent the current gold standard for managing and preventing postoperative ileus.
• Optimizing perioperative care through combined strategies significantly improves patient outcomes by reducing PI.