- Conor P. Delaney, MB, BCh
- Tong Joo (TJ) Gan, MD
- Michael D. Kraft, PharmD
- John B. Leslie, MD
- Robert MacLaren, PharmD
- John H. Marks, MD
- Theodore J. Saclarides, MD
- Anthony J. Senagore, MD
- Richard A. Steinbrook, MD
- Steven D. Wexner, MD
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What Is Postoperative Ileus?
Postoperative ileus (POI) is the transient impairment of coordinated bowel motility following surgery characterized by nausea, vomiting, abdominal distention and pain, and delayed passage of flatus and stool. POI is a common occurrence following abdominal and other surgeries, and may be associated with prolonged hospitalization, significant resource utilization, and diminished patient quality of life. The pathophysiology of POI is multifactorial, with neurogenic, hormonal, inflammatory and pharmacologic components. Surgical manipulation of the intestines results in activation of sympathetic pathways, which contributes to decreased intestinal motility. Hormonal and inflammatory mediators are generated as part of the surgical stress response, and activation of these pathways also contributes to POI. Endogenous and exogenous opioids inhibit peristaltic activity, delay gastric emptying and intestinal transit. There is increasing evidence that a multimodal approach to the management of patients undergoing gastrointestinal surgery may accelerate the restoration of normal gastrointestinal function, and reduce the length of hospital stay. The elements of a multimodal/fast track approach include minimally invasive surgery (where feasible), nasogastric tube removal, epidural analgesia, opioid-sparing techniques, early oral/enteral feeding, and early ambulation. Recent evidence indicates that peripherally-acting ยต-opioid receptor antagonists may accelerate GI tract recovery and reduce length of stay in patients undergoing bowel resection surgeries. This pharmacological approach may represent
an additional component of a multimodal strategy for the management of POI.
References
- Person B, Wexner S. The management of postoperative ileus. Curr Probl Surg. 2006;43:6-65.
- Maron D, Fry R. New therapies in the treatment of postoperative ileus after gastrointestinal surgery. Am J Therapeutics. 2008;15:59-65.
- Senagore A. Pathogenesis and clinical and economic consequences of postoperative ileus.
Am J Health-Syst Pharm. 2007;64(20 Suppl 13):S3-S7.
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