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  • Review Article
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New therapeutic strategies for postoperative ileus

Nature Reviews Gastroenterology & Hepatology volume 9, pages 675–683 (2012)Cite this article

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Abstract

Patients undergoing an abdominal surgical procedure develop a transient episode of impaired gastrointestinal motility or postoperative ileus. Importantly, postoperative ileus is a major determinant of recovery after intestinal surgery and leads to increased morbidity and prolonged hospitalization, which is a great economic burden to health-care systems. Although a variety of strategies reduce postoperative ileus, including multimodal postoperative rehabilitation (fast-track care) and minimally invasive surgery, none of these methods have been completely successful in shortening the duration of postoperative ileus. The aetiology of postoperative ileus is multifactorial, but insights into the pathogenesis of postoperative ileus have identified intestinal inflammation, triggered by surgical handling, as the main mechanism. The importance of this inflammatory response in postoperative ileus is underscored by the beneficial effect of pharmacological interventions that block the influx of leukocytes. New insights into the pathophysiology of postoperative ileus and the involvement of the innate and the adaptive (T-helper type 1 cell-mediated immune response) immune system offer interesting and important new approaches to prevent postoperative ileus. In this Review, we discuss the latest insights into the mechanisms behind postoperative ileus and highlight new strategies to intervene in the postoperative inflammatory cascade.

Key Points

  • Postoperative ileus can occur after intestinal surgery and leads to increased morbidity and prolonged hospitalization, placing an economic burden on health-care systems; no successful preventative treatment has been developed

  • Several techniques have been shown to reduce postoperative ileus including multimodal postoperative rehabilitation (fast-track care) and laparoscopic surgery

  • The aetiology of postoperative ileus is multifactorial and involves intestinal inflammation triggered by surgical procedures

  • Insights into the roles of the adaptive and innate arms of the immune system in the pathophysiology of postoperative ileus can be used to develop novel therapies

  • Some therapeutic approaches (ghrelin agonists, 5-HT4 receptor agonists and TU-100) are safe and reduce ileus duration in clinical trials but the mechanisms of their action are not completely understood

  • Improved understanding of the role of immune cells, particularly memory T-helper cells, and systemic inflammation in relation to the development of postoperative ileus could lead to new therapeutic strategies

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Figure 1: The vagal anti-inflammatory pathway and postoperative ileus.

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Acknowledgements

The authors' work was supported in part by governmental grants from Netherlands Organization for Scientific Research (NWO Vici grant 918-76 623), of the Flemish Fonds Wetenschappelijk Onderzoek (FWO), Odysseus program grant G.0905.07 and by the Maag Lever Darm Stichting (W09-30).

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Authors and Affiliations

  1. Department of Gastroenterology & Hepatology, Tytgat Institute of Liver and Intestinal Research, Academic Medical Center, Meibergdreef 69–71, Amsterdam, 1105 BK, The Netherlands

    Sjoerd H. W. van Bree & Cathy Cailotto

  2. Department of Clinical and Experimental Medicine, Department of Gastroenterology, Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, Catholic University of Leuven, Herestraat 49, Leuven, 3000, Belgium

    Andrea Nemethova, Pedro J. Gomez-Pinilla, Gianluca Matteoli & Guy E. Boeckxstaens

Authors
  1. Sjoerd H. W. van Bree
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  2. Andrea Nemethova
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  3. Cathy Cailotto
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  4. Pedro J. Gomez-Pinilla
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  5. Gianluca Matteoli
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  6. Guy E. Boeckxstaens
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Contributions

All authors contributed to researching, discussing, writing, reviewing and/or editing this manuscript. S. H. W. van Bree and A. Nemethova contributed equally to all aspects of the review.

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Correspondence to Guy E. Boeckxstaens.

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van Bree, S., Nemethova, A., Cailotto, C. et al. New therapeutic strategies for postoperative ileus. Nat Rev Gastroenterol Hepatol 9, 675–683 (2012). https://doi.org/10.1038/nrgastro.2012.134

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