title: Immune mediators of postoperative ileus.
abstract: CLINICAL BACKGROUND: In all patients undergoing abdominal surgery, a transient phase of interruption of bowel motility, named postoperative ileus (POI) occurs. POI is often accepted as an unavoidable "physiological" response and a self-limiting complication after surgery although it has a significant impact on patient morbidity with prolonged hospitalization and increased costs. Annual economic burden has been estimated as much as US $1.47 billion in the USA (Iyer et al. in J Manag Care Pharm 15(6):485-494, 2009).
  
  
  METHODS
  The pathophysiology has been elucidated within the last decades, demonstrating that both, neurogenic and inflammatory mechanisms are involved in response to the surgical trauma. It is now generally accepted that POI pathogenesis processes in two phases: a first neurogenic phase is accountable for the immediate postoperative impairment of bowel motility. This is followed by a second immunological phase that can last for days and mainly affects strength and length of POI. More recent findings demonstrate a bidirectional interaction between the nervous and the immune system, and this interaction significantly contributed to our present understanding of POI pathophysiology. Although nerval mechanisms have a significant impact in the early phase of POI, the contribution of the immune system and subsequently its manipulation has risen as the most promising strategy in prevention or treatment of the clinically relevant prolonged form of POI.
  
  
  OBJECTIVE
  The present manuscript will give an update on the inflammatory responses, the involved cell types, and participating immune mediators in POI.
authors.affiliation: Department of Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Wehner
authors.forename: Tim O
authors.initials: TO
authors.lastname: Vilz
authors.forename: Burkhard
authors.initials: B
authors.lastname: Stoffels
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Kalff
mesh_terms: D000818:Animals; D003713:Dendritic Cells / Q000502:physiology; D006801:Humans; D045823:Ileus / Q000503:physiopathology*; D018836:Inflammation Mediators / Q000097:blood*; D007413:Intestinal Mucosa / Q000503:physiopathology; D008264:Macrophages / Q000502:physiology; D008407:Mast Cells / Q000502:physiology; D055495:Neurogenesis / Q000502:physiology; D011183:Postoperative Complications / Q000503:physiopathology*; D020250:Postoperative Nausea and Vomiting / Q000503:physiopathology
chemical_list: D018836:Inflammation Mediators