Postoperative ileus—An ongoing conundrum

• Published in: Neurogastroenterology and motility Vol. 33; no. 5; pp. e14046 - n/a
• Main Authors: Wattchow, David, Heitmann, Paul, Smolilo, David, Spencer, Nick J., Parker, Dominic, Hibberd, Timothy, Brookes, Simon S. J., Dinning, Phil G., Costa, Marcello
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2021
• Subjects: Anesthesia, Epidural; Animal models; Animals; Benzofurans - therapeutic use; Chewing Gum; Cholinergic Agents - therapeutic use; Contrast Media - therapeutic use; Cyclooxygenase Inhibitors - therapeutic use; Diatrizoate Meglumine - therapeutic use; Digestive System Surgical Procedures - methods; Enhanced Recovery After Surgery; Enteral Nutrition; Enteric Nervous System - physiopathology; Fluid Therapy; Gastrointestinal Agents - therapeutic use; Gastrointestinal Motility - physiology; Ghrelin - therapeutic use; Humans; ileus; Ileus - immunology; Ileus - physiopathology; Ileus - prevention & control; Ileus - therapy; Inflammation - immunology; intestinal nervous system; Intestinal Pseudo-Obstruction - immunology; Intestinal Pseudo-Obstruction - physiopathology; Intestinal Pseudo-Obstruction - prevention & control; Intestinal Pseudo-Obstruction - therapy; Intubation, Gastrointestinal; Laboratory animals; Laparoscopy; Mast Cells - immunology; Piperidines - therapeutic use; postoperative; Postoperative Complications - immunology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Postoperative Complications - therapy; Serotonin 5-HT4 Receptor Agonists - therapeutic use; Sympathetic Nervous System - physiopathology; Sympatholytics - therapeutic use; postoperative; ileus; intestinal nervous system
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.14046

Background Postoperative ileus is common and is a major clinical problem. It has been widely studied in patients and in experimental models in laboratory animals. A wide variety of treatments have been tested to prevent or modify the course of this disorder. Purpose This review draws together information on animal studies of ileus with studies on human patients. It summarizes some of the conceptual advances made in understanding the mechanisms that underlie paralytic ileus. The treatments that have been tested in human subjects (both pharmacological and non‐pharmacological) and their efficacy are summarized and graded consistent with current clinical guidelines. The review is not intended to provide a comprehensive overview of ileus, but rather a general understanding of the major clinical problems associated with it, how animal models have been useful to elucidate key mechanisms and, finally, some perspectives from both scientists and clinicians as to how we may move forward with this debilitating yet common condition. This review provides a general understanding of the major clinical problems associated with postoperative ileus. It details how animal models have been useful to elucidate key mechanisms and provides perspectives from both scientists and clinicians as to how we may move forward with this debilitating yet common condition.