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Postoperative ileus—an update on preventive techniques

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 552–558 (2008)Cite this article

Abstract

This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number of techniques have been demonstrated to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess. Early institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open or laparoscopic abdominal surgery can be reduced to 24–48 h in most patients. There is a need for data on the effect of these techniques on POI when applied to major upper abdominal surgeries and emergency abdominal operations (e.g. trauma, peritonitis, etc.).

Key Points

  • Postoperative ileus (POI) is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay

  • Neural sympathetic inhibitory reflexes, opioids and intestinal inflammatory responses are thought to contribute to POI, and perioperative fluid excess is known to prolong POI

  • Several techniques have been shown to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess

  • Early institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use

  • The duration of POI after open or laparoscopic abdominal surgery can be reduced to 24–48 h in most patients by aggressive, multimodal postoperative rehabilitation (fast-track surgery)

  • Implementation of advances within perioperative care, including techniques to reduce the duration of POI (e.g. avoidance of nasogastric tubes, nonopioid analgesia, early feeding, mobilization, etc.), has been slow

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Author notes

  1. Section of Surgical Pathophysiology, 4074 Rigshospitalet, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen, Denmark henrik.kehlet@rh.regionh.dk

Authors and Affiliations

  1. H Kehlet is Professor of Perioperative Therapy at Copenhagen University and Head of Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Denmark,

    Henrik Kehlet

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Kehlet, H. Postoperative ileus—an update on preventive techniques. Nat Rev Gastroenterol Hepatol 5, 552–558 (2008). https://doi.org/10.1038/ncpgasthep1230

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