Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

• Published in: ANZ journal of surgery Vol. 90; no. 1-2; pp. 41 - 47
• Main Authors: Dudi‐Venkata, Nagendra N., Kroon, Hidde M., Bedrikovetski, Sergei, Moore, James W., Sammour, Tarik
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.01.2020; Blackwell Publishing Ltd
• Subjects: Bisacodyl - therapeutic use; Chewing Gum; Colonic Diseases - surgery; Colorectal surgery; Complications; enhanced recovery; Event-related potentials; gastrointestinal dysfunction; Humans; ileus; Ileus - drug therapy; Lactulose; Lactulose - therapeutic use; Laxatives; lower gastrointestinal; Magnesium; Neostigmine; Neostigmine - therapeutic use; Piperidines - therapeutic use; Postoperative Complications - drug therapy; Randomization; Recovery; Recovery of Function; Rectal Diseases - surgery; Reviews; Surgery; enhanced recovery; ileus; lower gastrointestinal; gastrointestinal dysfunction
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.15319

Background Post‐operative ileus (POI) and delayed return of gastrointestinal (GI) function are common complications after colorectal surgery. There is a lack of uniformity in enhanced recovery protocols (ERPs) with regards to interventions used to target these complications. This systematic review aims to categorize and summarize management recommendations available from published ERPs. Methods A systematic search of Ovid MEDLINE, Embase, Cochrane Library and PubMed databases was performed from January 1990 to May 2018. All studies publishing enhanced recovery or fast‐track or multimodal pathway protocols for colorectal surgery in their full‐text were included. Data on interventions aimed at reducing the duration of POI were extracted, as well as references quoted to support specific interventions. Results Of 481 manuscripts screened, 37 published ERPs were identified from 37 studies (18 cohort, seven historical‐control, five guidelines, four randomized controlled trials, one randomized controlled trial protocol, one case series and one narrative review). The most commonly recommended interventions were magnesium‐based laxatives (18 of 37, 48.6%), chewing gum (13 of 37, 35.1%), Alvimopan (6 of 37, 16.2%), lactulose (4 of 37, 10.8%), neostigmine (2 of 37, 5.4%) and bisacodyl (2 of 37, 5.4%). Geographical trends were noted for the various interventions, but high‐quality evidence was only referenced to support the use of Alvimopan. Conclusion ERP recommendations specific to interventions targeting POI and return of GI function are varied. While laxatives are the most commonly recommended intervention, there is only weak evidence reported to support this practice.