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Mechanisms and Treatment of Postoperative Ileus
Andrew Luckey, MD;
Edward Livingston, MD;
Yvette Taché, PhD
Arch Surg. 2003;138:206-214.
Objective To review the pathogenesis and treatment of postoperative ileus.
Data Sources Data collected for this review were identified from a MEDLINE database search of the English-language literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used.
Study Selection All relevant studies were included. Only articles that were case presentations or that mentioned postoperative ileus in passing were excluded.
Data Synthesis The pathogenesis of postoperative ileus is complex, with multiple factors contributing either simultaneously or at various times during the development of this entity. These factors include inhibitory effects of sympathetic input; release of hormones, neurotransmitters, and other mediators; an inflammatory reaction; and the effects of anesthetics and analgesics. Numerous treatments have been used to alleviate postoperative ileus without much success.
Conclusions The etiology of postoperative ileus can best be described as multifactorial. A multimodality treatment approach should include limiting the administration of agents known to contribute to postoperative ileus (narcotics), using thoracic epidurals with local anesthetics when possible, and selectively applying nasogastric decompression.
From the University of California at San Francisco–East Bay, Oakland (Dr Luckey); the Departments of Surgery (Dr Livingston) and Medicine (Dr Taché), The David Geffen School of Medicine, and the Bariatric Surgery Program (Dr Livingston), University of California at Los Angeles, and CURE: Digestive Diseases Research Center, VA Greater LA Healthcare System, Los Angeles (Dr Taché).
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