Postoperative ileus: Pathophysiology, incidence, and prevention.
Postoperative ileus (POI) is a major focus of concern for surgeons because it increases duration of hospitalization, cost of care, and postoperative morbidity. The definition of POI is relatively consensual albeit with a variable definition of interval to resolution ranging from 2 to 7 days for different authors. This variation, however, leads to non-reproducibility of studies and difficulties in interpreting the results. Certain risk factors for POI, such as male gender, advanced age and major blood loss, have been repeatedly described in the literature. Understanding of the pathophysiology of POI has helped combat and prevent its occurrence. But despite preventive and therapeutic efforts arising from such knowledge, 10 to 30% of patients still develop POI after abdominal surgery. In France, pharmacological prevention is limited by the unavailability of effective drugs. Perioperative nutrition is very important, as well as limitation of preoperative fasting to 6 hours for solid food and 2 hours for liquids, and virtually no fasting in the postoperative period. Coffee and chewing gum also play a preventive role for POI. The advent of laparoscopy has led to a significant improvement in the recovery of gastrointestinal function. Enhanced recovery programs, grouping together all measures for prevention or cure of POI by addressing the mechanisms of POI, has reduced the duration of hospitalization, morbidity and interval to resumption of transit.
L'UNAM, université d'Angers, 49933 Angers cedex, France; Inserm U913, université de Nantes, neuropathies du système nerveux entérique et maladies digestives, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie digestive et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France. Electronic address: auvenara@yahoo.fr.
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Venara
Inserm U913, université de Nantes, neuropathies du système nerveux entérique et maladies digestives, 1, rue Gaston-Veil, 44035 Nantes, France.
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Neunlist
Service de chirurgie digestive et endocrinienne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
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Slim
L'UNAM, université d'Angers, 49933 Angers cedex, France; Service de chirurgie digestive et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Barbieux
L'UNAM, université d'Angers, 49933 Angers cedex, France; Service de chirurgie digestive et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Colas
L'UNAM, université d'Angers, 49933 Angers cedex, France; Service de chirurgie digestive et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Hamy
Inserm U913, université de Nantes, neuropathies du système nerveux entérique et maladies digestives, 1, rue Gaston-Veil, 44035 Nantes, France; Service de chirurgie digestive et endocrinienne, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Meurette
D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015994:Incidence; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors
Management; Pathophysiology; Postoperative ileus; Prevention; Treatment