Postoperative ileus following major colorectal surgery

Area of Science:

• Gastroenterology
• Surgical Research
• Clinical Practice Guidelines

Background:

• Postoperative ileus (POI) is a common complication characterized by delayed gastrointestinal recovery after surgery.
• Understanding its pathophysiology, interventions, and research challenges is crucial for improving patient outcomes.

Purpose of the Study:

• To review current knowledge on the pathophysiology, clinical interventions, and methodological challenges of postoperative ileus.
• To inform modern clinical practice and guide future research in POI management.

Main Methods:

• A systematic literature search was conducted on MEDLINE and Embase for randomized controlled trials (RCTs) on POI prevention in colorectal surgery (1990-2016).
• Exclusion of grey literature and reanalyses; eligible articles were assessed for risk of bias using the Cochrane tool.

Main Results:

• 88 RCTs were identified, investigating mechanisms like neurogenic, inflammatory, and pharmacological factors, often based on animal studies.
• Interventions such as chewing gum and early enteral feeding are safe but show unclear benefits for reducing POI.
• Thoracic epidural analgesia, systemic lidocaine, and peripheral antagonists show promise but need further safety and cost-effectiveness evaluation.

Conclusions:

• Postoperative ileus (POI) currently lacks standardized definition, etiology, and treatment protocols.
• Minimally invasive surgery, protocol-driven recovery (early feeding, opioid avoidance), and prevention of inflammatory events (e.g., anastomotic leak) are the most effective strategies for POI reduction.