New therapeutic strategies for postoperative ileus.
Patients undergoing an abdominal surgical procedure develop a transient episode of impaired gastrointestinal motility or postoperative ileus. Importantly, postoperative ileus is a major determinant of recovery after intestinal surgery and leads to increased morbidity and prolonged hospitalization, which is a great economic burden to health-care systems. Although a variety of strategies reduce postoperative ileus, including multimodal postoperative rehabilitation (fast-track care) and minimally invasive surgery, none of these methods have been completely successful in shortening the duration of postoperative ileus. The aetiology of postoperative ileus is multifactorial, but insights into the pathogenesis of postoperative ileus have identified intestinal inflammation, triggered by surgical handling, as the main mechanism. The importance of this inflammatory response in postoperative ileus is underscored by the beneficial effect of pharmacological interventions that block the influx of leukocytes. New insights into the pathophysiology of postoperative ileus and the involvement of the innate and the adaptive (T-helper type 1 cell-mediated immune response) immune system offer interesting and important new approaches to prevent postoperative ileus. In this Review, we discuss the latest insights into the mechanisms behind postoperative ileus and highlight new strategies to intervene in the postoperative inflammatory cascade.
Tytgat Institute of Liver and Intestinal Research, Department of Gastroenterology & Hepatology, Academic Medical Center, Meibergdreef 69-71, 1105 BK Amsterdam, The Netherlands.
Sjoerd H W
SH
van Bree
Andrea
A
Nemethova
Cathy
C
Cailotto
Pedro J
PJ
Gomez-Pinilla
Gianluca
G
Matteoli
Guy E
GE
Boeckxstaens
D056704:Adaptive Immunity / Q000502:physiology; D054439:Ghrelin / Q000819:agonists; D006801:Humans; D045823:Ileus / Q000188:drug therapy* / Q000503:physiopathology*; D007113:Immunity, Innate / Q000502:physiology; D007249:Inflammation / Q000503:physiopathology; D009285:Naphthoquinones / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology*; D058828:Serotonin 5-HT4 Receptor Agonists / Q000627:therapeutic use
C559645:12,13-dihydro-N-methyl-6,11,13-trioxo-5H-benzo(4,5)cyclohepta(1,2-b)naphthalen-5,12-imine; D054439:Ghrelin; D009285:Naphthoquinones; D058828:Serotonin 5-HT4 Receptor Agonists