Measures to prevent prolonged postoperative ileus
- Jörg C Kalff, MD
Jörg C Kalff, MD
- Professor of Surgery
- University Medical Center, Bonn
- Sven Wehner, PhD
Sven Wehner, PhD
- University of Bonn
- Department of Surgery
- Babak Litkouhi, MD
Babak Litkouhi, MD
- Assistant Professor
- Yale School of Medicine
Prolonged postoperative ileus can increase patient pain and discomfort, contributes to prolonged hospitalization, and is a significant burden on the health care system.
There are few effective strategies for managing prolonged postoperative ileus once established, and thus, a more effective overall strategy minimizes factors that may precipitate or exacerbate the condition (table 1).
Measures used to prevent the development of prolonged postoperative ileus are reviewed here. The epidemiology, clinical features, diagnosis and supportive care of postoperative ileus, and prolonged postoperative ileus are reviewed elsewhere. (See "Postoperative ileus".)
PROLONGED POSTOPERATIVE ILEUS
Prolonged postoperative ileus is said to occur when the patient has symptoms or signs of paralytic ileus (obstipation and intolerance of oral intake) that persist for more than three to five days (depending on the nature of the surgery and what is considered "typical"), without evidence for mechanical bowel obstruction or other postoperative complications. (See "Postoperative ileus", section on 'Physiologic versus pathologic postoperative ileus' and "Postoperative ileus", section on 'Diagnosis'.)
Prolonged postoperative ileus can increase patient pain and discomfort, and decreases patient satisfaction with the surgical outcome . Prolonged delays in oral feeding can compromise postoperative nutrition, which can lead to greater postoperative catabolism, poor wound healing, susceptibility to infection, and the need for nutritional support [2,3]. These problems contribute to prolonged hospitalization and are a significant burden on the health care system [4-7].
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- PROLONGED POSTOPERATIVE ILEUS
- EFFECTIVE AND POTENTIALLY EFFECTIVE INTERVENTIONS
- Use of epidural with local anesthetics
- Minimally-invasive surgery
- Peripheral acting mu-opioid receptor antagonists
- Limiting opioid use
- Surgical technique
- Restriction of perioperative fluid administration
- Chewing gum
- Multimodal fast-track programs and laxatives
- INEFFECTIVE OR UNPROVEN INTERVENTIONS
- Early enteral nutrition
- Other dietary manipulations
- - Bran
- - Coffee
- Other pharmacologic treatments
- Early ambulation
- Visceral learning
- POTENTIALLY HARMFUL INTERVENTIONS
- Routine nasogastric tube placement
- COX-2 inhibition
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS