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 Feeding and the Incidence of Gastrointestinal Symptoms After Major Gynecologic Surgery
Objective To compare early feeding with traditional postoperative dietary management for development of postoperative gastrointestinal symptoms , including ileus after major gynecologic surgery for benign conditions . Methods Women who had major gynecologic surgery for benign conditions were r and omly allocated to early feeding of low residue diets 6 hours postoperatively or traditional dietary management of clear liquids with normal bowel sounds , and regular diet with passage of flatus . Demographic and perioperative data were collected , and patients answered question naires on their perception of bowel function and pain using the McGill Pain Scale . Power analysis found that 130 women were needed to find a twofold greater incidence of ileus in the early feeding group with 80 % power and & agr ; = .05 . Results Complete data were available for 139 women , 67 allocated to the early feeding group and 72 to the late feeding group . The incidence of postoperative ileus for the study population was 4.4 % and did not differ between groups ( early 3 % versus late 5.8 % , P = .68 ) . There were no differences in patient demographics , surgical procedures , anesthesia used , and intraoperative complications between groups . With the exception of more complaints of nausea in the late feeding group ( 23 % versus 13 % , P = .04 ) , there were no differences in other postoperative variables , including other perioperative complications , pain medicine requirements , fluid and caloric intake , median pain scores , and gastrointestinal function . The low incidence of perioperative complications made the power to detect differences between groups low . Conclusion Low residue diet 6 hours after major gynecologic surgery for benign indications was not associated with increased postoperative gastrointestinal complaints , including ileus
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 .