Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 8/2006

01-08-2006 | EDITORIAL UPDATE

Review of the Pathophysiology and Management of Postoperative Ileus

Authors: Peter Mattei, MD, John L. Rombeau, MD

Published in: World Journal of Surgery | Issue 8/2006

Login to get access

Abstract

Investigations in the pathophysiology and treatment of postoperative ileus continue to evolve. Bowel rest is no longer a mandatory component of postoperative recovery. Tolerance of enteral nutrition and normalization of the abdominal examination are more accurate indications of the resolution of postoperative ileus than passage of flatus or first bowel movement. A multimodal "fast track" recovery approach incorporated into a clinical pathway provides a more rapid return of intestinal function and shortened hospital stay in patients undergoing major, uncomplicated gastrointestinal surgery.
Literature
1.
Ballantyne GH. The meaning of ileus. Its changing definition over three millennia. Am J Surg 1984;148(2):252–256PubMedCrossRef
2.
3.
4.
5.
Luckey A, Livingston E, Tache Y. Mechanisms and treatment of postoperative ileus. Arch Surg 2003;138(2):206–214PubMedCrossRef
6.
Bauer AJ, Boeckxstaens GE. Mechanisms of postoperative ileus. Neurogastroenterol Motil 2004;16(Suppl 2):54–60PubMedCrossRef
7.
Cullen JJ, Eagon JC, Kelly KA. Gastrointestinal peptide hormones during postoperative ileus. Effect of octreotide. Dig Dis Sci 1994;39(6):1179–1184CrossRef
8.
Espat NJ, Cheng G, Kelley MC, et al. Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 1995;58(6):719–723PubMedCrossRef
9.
Bult H, Boeckxstaens GE, Pelckmans PA, et al. Nitric oxide as an inhibitory non-adrenergic non-cholinergic neurotransmitter. Nature 1990;345(6273):346–347PubMedCrossRef
10.
Kalff JC, Schraut WH, Billiar TR, et al. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 2000;118(2):316–327PubMedCrossRef
11.
12.
13.
Ferraz AA, Cowles VE, Condon RE, et al. Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg 1995;61(12):1079–1083PubMed
14.
Miedema BW, Johnson JO. Methods for decreasing postoperative gut dysmotility. Lancet Oncol 2003;4(6):365–372PubMedCrossRef
15.
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003;362(9399):1921–1928PubMedCrossRef
16.
Taguchi A, Sharma N, Saleem RM, et al. Selective postoperative inhibition of gastrointestinal opioid receptors. N Eng J Med 2001;345(13):935–940CrossRef
17.
Kehlet H, Williamson R, Buchler MW, et al. A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus. Colorectal Dis 2005;7(3):245–250PubMedCrossRef
18.
Kehlet H, Buchler MW, Beart RW Jr, et al. Care after colonic operation-is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 2006;202(1):45–54PubMedCrossRef
19.
Mangesi L, Hofmeyr GJ. Early compared with delayed oral fluids and food after caesarean section. Cochrane Database Syst Rev 2002;(3):CD003516
20.
Johnson Casto C, Krammer J, Drake J. Postoperative feeding: a clinical review. Obstet Gynecol Surv 2000;55(9):571–573PubMedCrossRef
21.
Sands DR, Wexner SD. Nasogastric tubes and dietary advancement after laparoscopic and open colorectal surgery. Nutrition 1999;15(5):347–350PubMedCrossRef
22.
Park HK, Kwak C, Byun SS, et al. Early removal of nasogastric tube after cystectomy with urinary diversion: does postoperative ileus risk increase? Urology 2005;65(5):905–908PubMedCrossRef
23.
Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005;92(6):673–680PubMedCrossRef
24.
Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2005;25(1):CD004929
25.
Cheatham ML, Chapman WC, Key SP, et al. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995;221(5):469–476PubMed
26.
Waldhausen JH, Schirmer BD. The effect of ambulation on recovery from postoperative ileus. Ann Surg 1990;212(6):671–677PubMed
27.
Asao T, Kuwano H, Nakamura J, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002;195(1):30–32PubMedCrossRef
28.
Holte K, Kehlet H. Postoperative ileus: progress towards effective management. Drugs 2002;62(18):2603–2615PubMedCrossRef
29.
Fox VJ, Miller J, McClung M. Nutritional support in the critically injured. Crit Care Nurs Clin North Am 2004;16(4):559–569PubMedCrossRef
30.
Yanagawa T, Bunn F, Roberts I, et al. Nutritional support for head-injured patients. Cochrane Database Syst Rev 2000;(2):CD001530
31.
Delaney CP. Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterol Motil 2004;16(Suppl 2):61–66PubMedCrossRef
32.
Kelley MC, Hocking MP, Marchand SD, et al. Ketorolac prevents postoperative small intestinal ileus in rats. Am J Surg 1993;165(1):107–111PubMed
33.
Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 2005;241(3):416–423PubMedCrossRef
34.
Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002;359(9320):1812–1818PubMedCrossRef
35.
36.
Foss JF, O’Connor MF, Yuan CS, et al. Safety and tolerance of methylnaltrexone in healthy humans: a randomized, placebo-controlled, intravenous, ascending-dose, pharmacokinetic study. J Clin Pharmacol 1997;37(1):25–30PubMed
37.
Delaney CP, Weese JL, Hyman NH, et al. Alvimopan postoperative ileus study group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum 2005;48(6):1114–1125PubMedCrossRef
38.
Wolff BG, Michelassi F, Gerkin TM, et al. Alvimopan postoperative ileus study group: alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg 2004;240(4):728–734PubMed
39.
De Winter BY, Boeckxstaens GE, De Man JG, et al. Effects of mu- and kappa-opioid receptors on postoperative ileus in rats. Eur J Pharmacol 1997;339(1):63–67PubMedCrossRef
40.
Bungard TJ, Kale-Pradhan PB. Prokinetic agents for the treatment of postoperative ileus in adults: a review of the literature. Pharmacotherapy 1999;19(4):416–423PubMedCrossRef
41.
Cheape JD, Wexner SD, James K, et al. Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial. Dis Colon Rectum 1991;34(6):437–441PubMedCrossRef
42.
Seta ML, Kale-Pradhan PB. Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Pharmacotherapy 2001;21(10):1181–1186PubMedCrossRef
43.
Bonacini M, Quiason S, Reynolds M, et al. Effect of intravenous erythromycin on postoperative ileus. Am J Gastroenterol 1993;88(2):208–211PubMed
44.
Smith AJ, Nissan A, Lanouette NM, et al. Prokinetic effect of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Dis Colon Rectum 2000;43(3):333–337PubMedCrossRef
45.
Vincent ME, Wetzner SM, Robbins AH. Pharmacology, clinical uses, and adverse effects of ceruletide, a cholecystokinetic agent. Pharmacotherapy 1982;2(4):223–234PubMed
46.
Sadek SA, Cranford C, Eriksen C, et al. Pharmacological manipulation of adynamic ileus: controlled randomized double-blind study of ceruletide on intestinal motor activity after elective abdominal surgery. Aliment Pharmacol Ther 1988;2(1):47–54PubMedCrossRef
47.
Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999;73(3):412–414PubMedCrossRef
48.
Basse L, Hjort Jakobsen D, Billesbolle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232(1):51–57PubMedCrossRef
49.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183(6):630–641PubMedCrossRef
50.
Basse L, Raskov HH, Hjort Jakobsen D, et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 2002;89(4):446–453PubMedCrossRef
51.
Delaney CP, Fazio VW, Senagore AJ, et al. ‚Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001;88(11):1533–1538PubMedCrossRef
52.
Basse L, Thorbol JE, Lossl K, et al. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004;47(3):271–277PubMedCrossRef
53.
Senagore AJ, Delaney CP, Mekhail N, et al. Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg 2003;90(10):1195–1199PubMedCrossRef
54.
Zutshi M, Delaney CP, Senagore AJ, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189(3):268–272PubMedCrossRef
Metadata
Title
Review of the Pathophysiology and Management of Postoperative Ileus
Authors
Peter Mattei, MD
John L. Rombeau, MD
Publication date
01-08-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 8/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0613-9

Other articles of this Issue 8/2006

World Journal of Surgery 8/2006 Go to the issue

OriginalPaper

Predictors for Complications after Loop Stoma Closure in Patients with Rectal Cancer

OriginalPaper

Can Biliary Carcinoembryonic Antigen Identify Colorectal Cancer Patients with Occult Hepatic Metastases?

OriginalPaper

Minimally Invasive Esophagectomy for Cancer: Prospective Evaluation of Laparoscopic Gastric Mobilization

OriginalPaper

Tolstoy’s Report of Five Cases of Chest Trauma: Its Relevance to Contemporary Military Surgical Experience

OriginalPaper

Specific Targeting of Pancreatic Islet Cells In Vivo by Insulin-Promoter-Driven Adenoviral Conjugated Reporter Genes

OriginalPaper

Understanding the Peer Review Process