Prolonged Ileus after Colorectal Surgery, a Systematic Review

Area of Science:

• Gastroenterology and Surgical Research
• Evidence Synthesis and Meta-Analysis
• Clinical Trial Methodology

Background:

• Prolonged post-operative ileus (POI) significantly impacts general surgery patients, particularly after colorectal surgery.
• Current understanding of POI etiology and pathophysiology is limited, with few effective management or preventative strategies.
• POI leads to adverse outcomes including prolonged hospitalization, increased costs, and patient morbidity.

Purpose of the Study:

• To systematically review and synthesize evidence on treatments for prolonged post-operative ileus following colorectal surgery.
• To evaluate the quality and certainty of evidence for various interventions using meta-analysis and confidence assessment tools.

Main Methods:

• Systematic literature review of randomized controlled trials (RCTs) comparing POI treatments.
• Network meta-analysis (NMA) for direct and indirect intervention comparisons.
• Confidence evaluation using CINeMA and certainty appraisal via GRADE; risk of bias assessed using Cochrane RoB2 tool.

Main Results:

• Seven studies were included, with most exhibiting significant within-study bias.
• High heterogeneity and incoherence precluded reliable pairwise meta-analysis and intervention ranking.
• Indirect comparisons derived from the network meta-analysis were deemed unreliable.

Conclusions:

• A substantial knowledge gap exists regarding prolonged ileus following digestive surgery.
• Current evidence is characterized by heterogeneity and incoherence, rather than mere imprecision.
• Further high-quality interventional trials are needed to address data gaps in POI occurrence and inform clinical practice.