AIMS AND OBJECTIVES: To determine how restored gastrointestinal motility can be accelerated after colorectal surgery. BACKGROUND: Regaining normal bowel functions after surgery is described as unexpectedly problematic. Postoperative ileus is expected after all surgery where the peritoneum is entered, and the length of surgery has little or no impact in terms of the duration of Postoperative ileus. There is some speculation about the best way to facilitate bowel motility after colorectal surgery. DESIGN: A systematic review. METHOD: The computerised databases Medline, Scopus and CINAHL were searched to locate randomised, controlled trials by using the following keywords: colorectal surgery, postoperative ileus, recovery of function and gastrointestinal motility. The systematic search was limited to studies published between January 2002-January 2012. Reference lists were also searched manually. RESULTS: A total of 34 randomised, controlled trials were included in the review. Recovery of gastrointestinal motility was accelerated when one of the following forms of treatment was administered: probiotics, early feeding in combination with multimodal regimens, pentoxifylline, flurbiprofen, valdecoxib, ketorolac, clonidine, ropivacaine, lidocaine or spinal analgesia. Gum chewing, preoperative carbohydrate loading, bisacodyl and Doppler-guided fluid management have an uncertain effect on bowel motility. The use of nonpharmacological interventions, intrathecal morphine, restricted fluid therapy and choline citrate yielded no significant acceleration in bowel motility. CONCLUSIONS: A multimodal treatment, where the use of morphine is restricted, seems to be the best way to accelerate the recovery of gastrointestinal bowel motility. However, more studies are required to optimise the multimodal protocol. RELEVANCE TO CLINICAL PRACTICE: The early return of bowel functions leads to quicker overall postoperative recovery, which may ease patient discomfort and decrease hospitalisation costs.
AIMS AND OBJECTIVES: To determine how restored gastrointestinal motility can be accelerated after colorectal surgery. BACKGROUND: Regaining normal bowel functions after surgery is described as unexpectedly problematic. Postoperative ileus is expected after all surgery where the peritoneum is entered, and the length of surgery has little or no impact in terms of the duration of Postoperative ileus. There is some speculation about the best way to facilitate bowel motility after colorectal surgery. DESIGN: A systematic review. METHOD: The computerised databases Medline, Scopus and CINAHL were searched to locate randomised, controlled trials by using the following keywords: colorectal surgery, postoperative ileus, recovery of function and gastrointestinal motility. The systematic search was limited to studies published between January 2002-January 2012. Reference lists were also searched manually. RESULTS: A total of 34 randomised, controlled trials were included in the review. Recovery of gastrointestinal motility was accelerated when one of the following forms of treatment was administered: probiotics, early feeding in combination with multimodal regimens, pentoxifylline, flurbiprofen, valdecoxib, ketorolac, clonidine, ropivacaine, lidocaine or spinal analgesia. Gum chewing, preoperative carbohydrate loading, bisacodyl and Doppler-guided fluid management have an uncertain effect on bowel motility. The use of nonpharmacological interventions, intrathecal morphine, restricted fluid therapy and choline citrate yielded no significant acceleration in bowel motility. CONCLUSIONS: A multimodal treatment, where the use of morphine is restricted, seems to be the best way to accelerate the recovery of gastrointestinal bowel motility. However, more studies are required to optimise the multimodal protocol. RELEVANCE TO CLINICAL PRACTICE: The early return of bowel functions leads to quicker overall postoperative recovery, which may ease patient discomfort and decrease hospitalisation costs.
Authors: Joseph C Carmichael; Deborah S Keller; Gabriele Baldini; Liliana Bordeianou; Eric Weiss; Lawrence Lee; Marylise Boutros; James McClane; Scott R Steele; Liane S Feldman Journal: Surg Endosc Date: 2017-08-03 Impact factor: 4.584
Authors: Zaid Al-Difaie; Nariaki Okamoto; Max H M C Scheepers; Didier Mutter; Laurents P S Stassen; Nicole D Bouvy; Jacques Marescaux; Bernard Dallemagne; Michele Diana; Mahdi Al-Taher Journal: Surg Endosc Date: 2022-10-18 Impact factor: 3.453
Authors: Georgia Herbert; Rachel Perry; Henning Keinke Andersen; Charlotte Atkinson; Christopher Penfold; Stephen J Lewis; Andrew R Ness; Steven Thomas Journal: Cochrane Database Syst Rev Date: 2019-07-22
Authors: Georgia Herbert; Rachel Perry; Henning Keinke Andersen; Charlotte Atkinson; Christopher Penfold; Stephen J Lewis; Andrew R Ness; Steven Thomas Journal: Cochrane Database Syst Rev Date: 2018-10-24
Authors: Annika Reintam Blaser; Jean-Charles Preiser; Sonja Fruhwald; Alexander Wilmer; Jan Wernerman; Carina Benstoem; Michael P Casaer; Joel Starkopf; Arthur van Zanten; Olav Rooyackers; Stephan M Jakob; Cecilia I Loudet; Danielle E Bear; Gunnar Elke; Matthias Kott; Ingmar Lautenschläger; Jörn Schäper; Jan Gunst; Christian Stoppe; Leda Nobile; Valentin Fuhrmann; Mette M Berger; Heleen M Oudemans-van Straaten; Yaseen M Arabi; Adam M Deane Journal: Crit Care Date: 2020-05-15 Impact factor: 9.097