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Clin Colon Rectal Surg 2009; 22(1): 047-050
DOI: 10.1055/s-0029-1202886
© Thieme Medical Publishers

Pathogenesis and Management of Postoperative Ileus

James Carroll1 , Karim Alavi2
  • 1Surgical Outcomes Analysis and Research, Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
  • 2Department of Surgery, Section of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
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Publication History

Publication Date:
09 March 2009 (online)

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ABSTRACT

Postoperative ileus (POI) is a predictable delay in gastrointestinal (GI) motility that occurs after abdominal surgery. Probable mechanisms include disruption of the sympathetic/parasympathetic pathways to the GI tract, inflammatory changes mediated over multiple pathways, and the use of opioids for the management of postoperative pain. Pharmacologic treatment of postoperative ileus continues to be problematic as most agents are unreliable and unsubstantiated with robust clinical trials. The selective opioid antagonist alvimopan has shown promise in reducing POI, but needs more rigorous investigation. Clinician interventions proven to be of benefit include laparoscopy, thoracic epidural anesthesia, avoidance of opioids, and early feeding. Early ambulation may also contribute to early resolution of POI; however, routine nasogastric decompression plays no role and may increase complications. Multimodal care plans remain the mainstay of treatment for POI.

KEYWORDS

Postoperative ileus - motility - postoperative patient care - postoperative stay

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Karim AlaviM.D. 

Department of Surgery, Section of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center

67 Belmont St., Worcester, MA 01605

Email: alavik@ummhc.org

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