title: [Immunomodulatory aspects in the development, prophylaxis and therapy for postoperative ileus].
abstract: Postoperative ileus (POI) is defined as a transient episode of impaired gastrointestinal motility after abdominal surgery, which prevents effective transit of intestinal contents or tolerance of oral intake. This frequent postoperative complication is accompanied by a considerable increase in morbidity and hospitalisation costs. The aetiology of POI is multifactorial. Besides a suppression of peristalsis by inhibitory neuronal signalling and administration of opioids, particularly in the prolonged form, immunological processes play an important role. After surgical trauma, resident macrophages of the muscularis externa (ME) are activated leading to the liberation of proinflammatory mediators and a spreading of the inflammation along the entire gastrointestinal tract. To date, no prophylaxis or evidence-based single approach exists to treat POI. Since none of the current treatment approaches (i.e., prokinetic drug treatment) has provided a benefit in randomised trials, immunoregulatory interventions appear to be more promising in POI prevention or treatment. The present contribution gives an overview of immunological mechanisms leading to POI focusing on current and future therapeutic and prophylactic approaches.
authors: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
authors: T O
authors: TO
authors: Vilz
authors: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
authors: S
authors: S
authors: Wehner
authors: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
authors: D
authors: D
authors: Pantelis
authors: Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
authors: J C
authors: JC
authors: Kalff
mesh_terms: D006801:Humans; D056747:Immunomodulation / Q000276:immunology*; D018836:Inflammation Mediators / Q000378:metabolism; D007418:Intestinal Pseudo-Obstruction / Q000276:immunology* / Q000517:prevention & control / Q000628:therapy*; D008262:Macrophage Activation / Q000276:immunology; D008264:Macrophages / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology* / Q000517:prevention & control / Q000628:therapy*; D011379:Prognosis
chemical_list: D018836:Inflammation Mediators