Non-Pharmacologic Manual Therapies for Postoperative Bowel Dysfunction: A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Surgical Recovery
• Evidence-Based Medicine

Background:

• Postoperative bowel dysfunction is a frequent complication, leading to increased morbidity and prolonged hospital stays.
• Delayed gastrointestinal recovery and postoperative ileus significantly impact patient outcomes.
• Manual therapies are explored as potential interventions to mitigate these complications.

Purpose of the Study:

• To systematically review and meta-analyze the effects of manual therapies on postoperative bowel function.
• To evaluate osteopathic manipulative treatment (OMT) and abdominal massage in enhancing gastrointestinal recovery.
• To assess the impact on time to first bowel movement, time to first flatus, and hospital length of stay.

Main Methods:

• Systematic review and meta-analysis of 17 studies.
• Searched databases including MEDLINE/PubMed, Google Scholar, Cochrane Library, Semantic Scholar, and ClinicalTrials.gov.
• Assessed risk of bias and certainty using GRADE framework; performed random-effects meta-analyses.

Main Results:

• Both OMT and abdominal massage significantly reduced the time to the first bowel movement compared to controls.
• OMT was associated with a significantly shorter hospital length of stay.
• Trends favored manual therapy for time to first flatus, but results were not statistically significant and showed substantial heterogeneity.

Conclusions:

• Manual therapy shows potential for accelerating postoperative bowel recovery.
• Methodological limitations and heterogeneity necessitate cautious interpretation of findings.
• Further high-quality, multicenter studies are required to confirm clinical significance and reproducibility.