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 .
Reduction of Postoperative Complication Rate with the Use of Early Oral Feeding in Gynecologic Oncologic Patients Undergoing a Major Surgery: A Randomized Controlled Trial
Background A r and omized controlled trial was performed to assess the outcome of early oral postoperative feeding ( EOF ) compared with traditional oral feeding ( TOF ) in gynecologic oncology patients undergoing a complex laparotomy , including upper abdominal surgery . Methods Patients aged 18–75 years , undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy , were eligible . Exclusion criteria included infectious conditions , intestinal obstruction , severe malnutrition , American Society of Anesthesiologists score ≥4 , intestinal resection , and postoperative stay in the intensive care unit lasting > 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet . Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet . The primary end-point of the trial was length of hospital stay . Results Between January 1 , 2007 , and November 17 , 2007 , a total of 143 patients were r and omized to receive either EOF or TOF . Hospital stay for patients who received EOF ( n = 71 ) was 4.7 vs. 5.8 days for the TOF group ( n = 72 ) ( P = 0.006 ) . The mean level of postoperative satisfaction was significantly higher in the EOF group ( 82.8 vs. 71.7 mm , P ≤ 0.001 ) . Patients who received the TOF scheme had significantly higher overall postoperative complications ( 39 vs. 17 % in EOF group , P = 0.003 ) and infective complications ( 14 % in TOF group vs. 3 % in EOF group , P = 0.017 ) . Variables such as nausea and vomiting , analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups . Conclusions On the basis of these findings , the policy of EOF should be used after a complex gynecologic oncologic laparotomy
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 .