title: Facilitating early recovery of bowel motility after colorectal surgery: a systematic review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A systematic review.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The early return of bowel functions leads to quicker overall postoperative recovery, which may ease patient discomfort and decrease hospitalisation costs.
authors.affiliation: Department of Surgery, County Council of Östergötland, Linköping, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Wallström
authors.forename: Gunilla Hollman
authors.initials: GH
authors.lastname: Frisman
mesh_terms: D003107:Colorectal Surgery; D005769:Gastrointestinal Motility; D006801:Humans
keywords: colorectal surgery; enhanced recovery; gastrointestinal motility; multimodal treatment; postoperative care