Mechanisms and treatment of postoperative ileus.
OBJECTIVE
To review the pathogenesis and treatment of postoperative ileus.


METHODS
Data collected for this review were identified from a MEDLINE database search of the English-language literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used.


METHODS
All relevant studies were included. Only articles that were case presentations or that mentioned postoperative ileus in passing were excluded.


RESULTS
The pathogenesis of postoperative ileus is complex, with multiple factors contributing either simultaneously or at various times during the development of this entity. These factors include inhibitory effects of sympathetic input; release of hormones, neurotransmitters, and other mediators; an inflammatory reaction; and the effects of anesthetics and analgesics. Numerous treatments have been used to alleviate postoperative ileus without much success.


CONCLUSIONS
The etiology of postoperative ileus can best be described as multifactorial. A multimodality treatment approach should include limiting the administration of agents known to contribute to postoperative ileus (narcotics), using thoracic epidurals with local anesthetics when possible, and selectively applying nasogastric decompression.
Luckey
Andrew
A
University of California at Sanf Francisco-East Bay, Oakland, USA. LuckeyA@surgery.uscf.edu
Livingston
Edward
E
Taché
Yvette
Y
D000701:Analgesics, Opioid; D000758:Anesthesia; D001341:Autonomic Nervous System / Q000503:physiopathology; D005769:Gastrointestinal Motility; D006728:Hormones / Q000502:physiology; D006801:Humans; D007249:Inflammation; D007415:Intestinal Obstruction / Q000209:etiology* / Q000628:therapy*; D018377:Neurotransmitter Agents / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy*
D000701:Analgesics, Opioid; D006728:Hormones; D018377:Neurotransmitter Agents