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

Background: Postoperative bowel dysfunction, including delayed gastrointestinal recovery and postoperative ileus, is a common complication that increases morbidity and prolongs hospitalization. In this systematic review and meta-analysis, we evaluated the effects of manual therapies on postoperative bowel function. Methods: MEDLINE/PubMed, Google Scholar, the Cochrane Library, Semantic Scholar, and ClinicalTrials.gov were searched from database inception up to 17 March 2026, and studies evaluating osteopathic manipulative treatment (OMT) or abdominal massage in postoperative patients were included in our analysis. Risk of bias and certainty were assessed using validated study design-specific tools, including the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Random-effects meta-analyses were performed for the prespecified outcomes of time to first bowel movement, time to first flatus, and hospital length of stay. Results: Seventeen studies met our inclusion criteria. Both OMT and abdominal massage were associated with a significantly shorter time to first bowel movement compared with controls (OMT: mean difference [MD] -0.57 days, 95% CI -0.96 to -0.18; abdominal massage: MD -0.91 days, 95% CI -1.47 to -0.35). OMT was also associated with reduced hospital length of stay (MD -2.46 days, 95% CI -4.52 to -0.41), while time to first flatus demonstrated favorable but non-significant trends, with substantial heterogeneity. Conclusions: Manual therapy may be associated with earlier postoperative bowel recovery, although heterogeneity and methodological limitations warrant cautious interpretation. Further high-quality multicenter studies are needed to clarify the clinical significance and reproducibility of these findings.