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 Versus Delayed Postoperative Feeding After Major Gynaecological Surgery and its Effects on Clinical Outcomes, Patient Satisfaction, and Length of Stay: A Randomized Controlled Trial.
OBJECTIVE To compare early versus delayed postoperative feeding in women undergoing major gynaecological surgery with regard to clinical outcomes , duration of postoperative stay , and patient satisfaction . METHODS We conducted a parallel-r and omized controlled trial at a tertiary care centre in Montreal , Quebec , between June 2000 and July 2001 . Patients undergoing major gynaecological surgery were r and omized following a 1:1 allocation ratio to receive either early postoperative feeding in which oral clear fluids were begun up to six hours after surgery followed by solid foods as tolerated , or delayed postoperative feeding , in which clear fluids were begun on the first postoperative day and solid foods on the second or third day as tolerated . The primary outcomes analyzed were duration of postoperative stay and patient satisfaction . Secondary outcomes included mean time to appetite , passage of flatus , and bowel movement , as well as the presence of symptoms of paralytic ileus . RESULTS A total of 119 patients were r and omized ; 61 patients were assigned to the early feeding group and 58 to the delayed feeding group . Demographic characteristics , including age , weight , smoking status , and prior surgical history were comparable between both groups . There was no difference in length of postoperative stay between the two groups ( 86.4 ± 21.0 hours in the early feeding group vs. 85.6 ± 26.2 hours in the delayed feeding group ; P > 0.05 ) . No significant difference was noted in patient satisfaction ( P > 0.05 ) . No difference was found in the frequency of postoperative ileus , mean time to appetite , passage of flatus , or first bowel movement . CONCLUSION The introduction of early postoperative feeding appears to be safe and well tolerated by patients undergoing major gynaecological surgery .  The duration of postoperative stay , patient satisfaction , and gastrointestinal symptoms are comparable between patients undergoing early or delayed postoperative feeding
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 .