Postoperative Ileus

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Intestinal Failure
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Abstract

One of the most disheartening situations in abdominal surgery is having a patient who, after initially appearing to be doing well, develops abdominal distension and vomiting and requires intravenous fluids or parenteral nutrition. The resulting postoperative ileus may last for days to weeks and is a form of intestinal failure. Some surgeons suggest that they do not see this problem while others recognise this is the most common complication following abdominal surgery.

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References

  1. van Bree SH, Bemelman WA, Hollmann MW, Zwinderman AH, Matteoli G, El Temna S, et al. Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus. Ann Surg. 2014;259(4):708–14.

    PubMed  Google Scholar 

  2. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg. 2013;17(5):962–72.

    PubMed  Google Scholar 

  3. van den Heijkant TC, Costes LM, van der Lee DG, Aerts B, Osinga-de Jong M, Rutten HR, et al. Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. Br J Surg. 2015;102(3):202–11.

    PubMed  Google Scholar 

  4. Peters EG, Smeets BJ, Dekkers M, Buise MD, de Jonge WJ, Slooter GD, et al. The effects of stimulation of the autonomic nervous system via perioperative nutrition on postoperative ileus and anastomotic leakage following colorectal surgery (SANICS II trial): a study protocol for a double-blind randomized controlled trial. Trials. 2015;16:20.

    PubMed  PubMed Central  Google Scholar 

  5. Vilz TO, Pantelis D, Lingohr P, Fimmers R, Esmann A, Randau T, et al. SmartPill(R) as an objective parameter for determination of severity and duration of postoperative ileus: study protocol of a prospective, two-arm, open-label trial (the PIDuSA study). BMJ Open. 2016;6(7):e011014.

    PubMed  PubMed Central  Google Scholar 

  6. Kronberg U, Kiran RP, Soliman MS, Hammel JP, Galway U, Coffey JC, et al. A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg. 2011;253(1):78–81.

    PubMed  Google Scholar 

  7. Wolthuis AM, Bislenghi G, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D’Hoore A. Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Color Dis. 2016;18(1):O1–9.

    CAS  Google Scholar 

  8. Yorkshire Surgical Research Collaborative. Multicentre observational study of gastrointestinal recovery after elective colorectal surgery. Color Dis. 2018;20(6):536–44.

    Google Scholar 

  9. Scarborough JE, Schumacher J, Kent KC, Heise CP, Greenberg CC. Associations of specific postoperative complications with outcomes after elective colon resection: a procedure-targeted approach toward surgical quality improvement. JAMA Surg. 2017;152(2):e164681.

    PubMed  Google Scholar 

  10. Vather R, Josephson R, Jaung R, Kahokehr A, Sammour T, Bissett I. Gastrografin in prolonged postoperative ileus: a double-blinded randomized controlled trial. Ann Surg. 2015;262(1):23–30.

    PubMed  Google Scholar 

  11. Goldstein JL, Matuszewski KA, Delaney C, Senagore A, Chiao E, Shah M, et al. Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States. P T. 2007;32(2):82–90.

    Google Scholar 

  12. Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm. 2009;15(6):485–94.

    PubMed  Google Scholar 

  13. Vather R, O'Grady G, Bissett IP, Dinning PG. Postoperative ileus: mechanisms and future directions for research. Clin Exp Pharmacol Physiol. 2014;41(5):358–70.

    CAS  PubMed  Google Scholar 

  14. Artinyan A, Nunoo-Mensah JW, Balasubramaniam S, Gauderman J, Essani R, Gonzalez-Ruiz C, et al. Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg. 2008;32(7):1495–500.

    PubMed  Google Scholar 

  15. Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E. Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World J Surg. 2012;36(1):179–85.

    PubMed  Google Scholar 

  16. Chapuis PH, Bokey L, Keshava A, Rickard MJ, Stewart P, Young CJ, et al. Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg. 2013;257(5):909–15.

    PubMed  Google Scholar 

  17. Vather R, Josephson R, Jaung R, Robertson J, Bissett I. Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery. 2015;157(4):764–73.

    PubMed  Google Scholar 

  18. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr. 2015;34(3):367–76.

    PubMed  Google Scholar 

  20. Delaney CP. Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterol Motil. 2004;16(Suppl 2):61–6.

    PubMed  Google Scholar 

  21. Ferguson JF, Patel PN, Shah RY, Mulvey CK, Gadi R, Nijjar PS, et al. Race and gender variation in response to evoked inflammation. J Transl Med. 2013;11:63.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Huskisson EC. Catecholamine excretion and pain. Br J Clin Pharmacol. 1974;1(1):80–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Kalff JC, Schraut WH, Simmons RL, Bauer AJ. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg. 1998;228(5):652–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Vather R, Bissett IP. Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery. Int J Color Dis. 2013;28(10):1385–91.

    Google Scholar 

  25. Chowdhury AH, Lobo DN. Fluids and gastrointestinal function. Curr Opin Clin Nutr Metab Care. 2011;14(5):469–76.

    PubMed  Google Scholar 

  26. Venara A, Duchalais E, Dariel A, Aubert P, Durand T, Meurette G, et al. Anti-inflammatory effects of enhanced recovery programs on early-stage colorectal cancer surgery. World J Surg. 2018;42(4):953–64.

    PubMed  Google Scholar 

  27. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434–40.

    PubMed  Google Scholar 

  28. Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis. 2014;16(12):947–56.

    CAS  Google Scholar 

  29. VandeHei MS, Papageorge CM, Murphy MM, Kennedy GD. The effect of perioperative fluid management on postoperative ileus in rectal cancer patients. Surgery. 2017;161(6):1628–32.

    PubMed  Google Scholar 

  30. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359(9320):1812–8.

    PubMed  Google Scholar 

  31. Gomez-Izquierdo JC, Trainito A, Mirzakandov D, Stein BL, Liberman S, Charlebois P, et al. Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a Randomized Controlled Trial. Anesthesiology. 2017;127(1):36–49.

    PubMed  Google Scholar 

  32. Kalyan JP, Rosbergen M, Pal N, Sargen K, Fletcher SJ, Nunn DL, et al. Randomized clinical trial of fluid and salt restriction compared with a controlled liberal regimen in elective gastrointestinal surgery. Br J Surg. 2013;100(13):1739–46.

    CAS  PubMed  Google Scholar 

  33. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378(24):2263–74.

    PubMed  Google Scholar 

  34. Chapman SJ, Pericleous A, Downey C, Jayne DG. Postoperative ileus following major colorectal surgery. Br J Surg. 2018;105(7):797–810.

    CAS  PubMed  Google Scholar 

  35. Short V, Herbert G, Perry R, Atkinson C, Ness AR, Penfold C, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;2:CD006506.

    Google Scholar 

  36. Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016;7:CD001893.

    PubMed  Google Scholar 

  37. Halabi WJ, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, et al. Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes. JAMA Surg. 2014;149(2):130–6.

    PubMed  Google Scholar 

  38. Gavriilidis P, Katsanos K. Laparoscopic versus open transverse colectomy: a systematic review and meta-analysis. World J Surg. 2018;42(9):3008–14.

    PubMed  Google Scholar 

  39. Schwenk W, Bohm B, Haase O, Junghans T, Muller JM. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbeck's Arch Surg. 1998;383(1):49–55.

    CAS  Google Scholar 

  40. Basse L, Madsen JL, Billesbolle P, Bardram L, Kehlet H. Gastrointestinal transit after laparoscopic versus open colonic resection. Surg Endosc. 2003;17(12):1919–22.

    CAS  PubMed  Google Scholar 

  41. van Bree SH, Vlug MS, Bemelman WA, Hollmann MW, Ubbink DT, Zwinderman AH, et al. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Gastroenterology. 2011;141(3):872–80 e1–4.

    PubMed  Google Scholar 

  42. Delaney CP, Weese JL, Hyman NH, Bauer J, Techner L, Gabriel K, et al. 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):1114–25; discussion 25–6; author reply 27–9

    PubMed  Google Scholar 

  43. Ludwig K, Enker WE, Delaney CP, Wolff BG, Du W, Fort JG, et al. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008;143(11):1098–105.

    CAS  PubMed  Google Scholar 

  44. Viscusi ER, Goldstein S, Witkowski T, Andonakakis A, Jan R, Gabriel K, et al. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc. 2006;20(1):64–70.

    CAS  PubMed  Google Scholar 

  45. Wolff BG, Michelassi F, Gerkin TM, Techner L, Gabriel K, Du W, et al. 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):728–34; discussion 34–5

    PubMed  PubMed Central  Google Scholar 

  46. Narita K, Tsunoda A, Takenaka K, Watanabe M, Nakao K, Kusano M. Effect of mosapride on recovery of intestinal motility after hand-assisted laparoscopic colectomy for carcinoma. Dis Colon Rectum. 2008;51(11):1692–5.

    PubMed  Google Scholar 

  47. Brown TA, McDonald J, Williard W. A prospective, randomized, double-blinded, placebo-controlled trial of cisapride after colorectal surgery. Am J Surg. 1999;177(5):399–401.

    CAS  PubMed  Google Scholar 

  48. Milne TGE, Jaung R, O'Grady G, Bissett IP. Nonsteroidal anti-inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta-analysis. Color Dis. 2018;20(8):O190–O8.

    CAS  Google Scholar 

  49. Smith SA, Roberts DJ, Lipson ME, Buie WD, MacLean AR. Postoperative nonsteroidal anti-inflammatory drug use and intestinal anastomotic dehiscence: a systematic review and meta-analysis. Dis Colon Rectum. 2016;59(11):1087–97.

    PubMed  Google Scholar 

  50. Dulskas A, Klimovskij M, Vitkauskiene M, Samalavicius NE. Effect of coffee on the length of postoperative ileus after elective laparoscopic left-sided colectomy: a randomized, prospective single-center study. Dis Colon Rectum. 2015;58(11):1064–9.

    PubMed  Google Scholar 

  51. Vather R, Bissett I. Management of prolonged post-operative ileus: evidence-based recommendations. ANZ J Surg. 2013;83(5):319–24.

    PubMed  Google Scholar 

  52. Milne TGE, Vather R, O'Grady G, Miquel J, Biondo S, Bissett I. Gastrografin may reduce time to oral diet in prolonged post-operative ileus: a pooled analysis of two randomized trials. ANZ J Surg. 2018;88:E578–82.

    Google Scholar 

  53. Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.

    PubMed  Google Scholar 

  54. Sandstrom R, Drott C, Hyltander A, Arfvidsson B, Schersten T, Wickstrom I, et al. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 1993;217(2):185–95.

    CAS  PubMed  PubMed Central  Google Scholar 

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Bissett, I., Lobo, D.N. (2023). Postoperative Ileus. In: Nightingale, J.M. (eds) Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-031-22265-8_4

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  • DOI: https://doi.org/10.1007/978-3-031-22265-8_4

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