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Perspectives on the importance of postoperative ileus.
Curr Med Res Opin 2015; 31(4):675-6CM

Abstract

Post-operative ileus (POI) is a common condition after surgery. Failure to restore adequate bowel function after surgery generates a series of complications and it is associated to patients frustration and discomfort, worsening their perioperative experience. Even mild POI can be source of anxiety and could be perceived as a drop out from the "straight-forward" pathway. Enhanced recovery programmes have emphasized the importance of early commencement of oral diet, avoiding the ancient dogmata of prolonged gastric decompression and fasting. These protocols with early oral feeding and mobilization have led to improved perioperative management and have decreased hospital length of stay, ameliorating patient's postoperative experience as well. Nonetheless, the incidence of POI is still high especially after major open abdominal surgery. In order to decrease the incidence of POI, minimally-invasive surgical approaches and minimization of surgical manipulation have been suggested. From a pharmacological perspective, a meta-analysis of pro-kinetics showed beneficial results with alvimopan, although its use has been limited by the augmented risk of myocardial infarction and the high costs. A more simple approach based on the postoperative use of chewing-gum has provided some benefits in restoring bowel function. From an anaesthesiological perspective, epidural anaesthesia/analgesia does not only reduce the postoperative consumption of systemic opioids but directly improve gastrointestinal function and should be considered where possible, at least for open surgical procedures. POI represents a common and debilitating complication that should be challenged with multi-disciplinary approach. Prospective research is warranted on this field and should focus also on patient s reported outcomes.

Authors+Show Affiliations

Cardiothoracic Intensive Care Unit, Intensive Care Directorate, St George's Hospital , London , UK.No affiliation info available

Pub Type(s)

Editorial

Language

eng

PubMed ID

25753356

Citation

Sanfilippo, Filippo, and Gabriele Spoletini. "Perspectives On the Importance of Postoperative Ileus." Current Medical Research and Opinion, vol. 31, no. 4, 2015, pp. 675-6.
Sanfilippo F, Spoletini G. Perspectives on the importance of postoperative ileus. Curr Med Res Opin. 2015;31(4):675-6.
Sanfilippo, F., & Spoletini, G. (2015). Perspectives on the importance of postoperative ileus. Current Medical Research and Opinion, 31(4), pp. 675-6. doi:10.1185/03007995.2015.1027184.
Sanfilippo F, Spoletini G. Perspectives On the Importance of Postoperative Ileus. Curr Med Res Opin. 2015;31(4):675-6. PubMed PMID: 25753356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perspectives on the importance of postoperative ileus. AU - Sanfilippo,Filippo, AU - Spoletini,Gabriele, PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/8/13/medline KW - Alvimopan KW - Chewing gum KW - Epidural anesthesia KW - Laparoscopic surgery KW - Open lower abdominal surgery KW - Postoperative ileus SP - 675 EP - 6 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 31 IS - 4 N2 - Post-operative ileus (POI) is a common condition after surgery. Failure to restore adequate bowel function after surgery generates a series of complications and it is associated to patients frustration and discomfort, worsening their perioperative experience. Even mild POI can be source of anxiety and could be perceived as a drop out from the "straight-forward" pathway. Enhanced recovery programmes have emphasized the importance of early commencement of oral diet, avoiding the ancient dogmata of prolonged gastric decompression and fasting. These protocols with early oral feeding and mobilization have led to improved perioperative management and have decreased hospital length of stay, ameliorating patient's postoperative experience as well. Nonetheless, the incidence of POI is still high especially after major open abdominal surgery. In order to decrease the incidence of POI, minimally-invasive surgical approaches and minimization of surgical manipulation have been suggested. From a pharmacological perspective, a meta-analysis of pro-kinetics showed beneficial results with alvimopan, although its use has been limited by the augmented risk of myocardial infarction and the high costs. A more simple approach based on the postoperative use of chewing-gum has provided some benefits in restoring bowel function. From an anaesthesiological perspective, epidural anaesthesia/analgesia does not only reduce the postoperative consumption of systemic opioids but directly improve gastrointestinal function and should be considered where possible, at least for open surgical procedures. POI represents a common and debilitating complication that should be challenged with multi-disciplinary approach. Prospective research is warranted on this field and should focus also on patient s reported outcomes. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/25753356/Perspectives_on_the_importance_of_postoperative_ileus_ L2 - http://www.tandfonline.com/doi/full/10.1185/03007995.2015.1027184 DB - PRIME DP - Unbound Medicine ER -