Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .
Early Oral Feeding Versus Traditional Postoperative Care After Abdominal Emergency Surgery: A Randomized Controlled Trial
Background Early oral feeding ( EOF ) has been demonstrated to be safe and beneficial after abdominal elective surgery . The aim of this r and omized controlled trial is to assess the safety and benefits of EOF compared to traditional postoperative care ( TPC ) after abdominal emergency surgery . Methods Patients assigned to the EOF group commenced a soft diet within 24 h after surgery . In the TPC group , a liquid diet was commenced upon passage of flatus or stool and then advanced to soft food . The primary endpoint was the complication rate . Secondary endpoints were severity of complications , mortality , gastrointestinal leaks , surgical-site infection , reoperation , diet intolerance , time to first flatus and stool , amount of food intake , postoperative discomfort , hospital stay , weight loss at the 15th postoperative day and incisional hernias . Results A total of 295 patients assigned to EOF ( n = 148 ) or TPC ( n = 147 ) were analyzed . No significant differences were seen in the complications rates ( EOF 45.3 % vs. TPC 37.4 % ; p = 0.1 ) . There was a significantly higher rate of vomiting with EOF ( EOF 13.5 % vs. TPC 6.1 % ; p = 0.03 ) , with no differences in nasogastric tube reinsertion . EOF patients ’ food intake was proportionally lower for the first three meals than that of TPC patients ( p < 0.01 ) . Postoperative discomfort survey revealed more hunger in the TPC group ( p < 0.01 ) . There were no differences in postoperative ileus or length of hospital stay . Conclusions EOF was safe after abdominal emergency surgery . EOF was associated with more vomiting ( treated easily and without patient discomfort ) and less hunger than with TPC . No other EOF-related benefits could be demonstrated during this trial
Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .