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 .
A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra‐abdominal Surgery
Objective To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients . Methods During a 1-year period , 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a r and omized controlled trial of early compared with traditional oral postoperative feeding . Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated . Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function ( defined as the passage of flatus in the absence of vomiting or abdominal distention ) , then began a clear liquid diet , and advanced to a regular diet as tolerated . Results Age , case distribution , surgery length , blood loss , and first passage of flatus were similar in the early and traditional feeding groups . Significantly more patients in the early group developed nausea . Despite this , the incidence of vomiting , abdominal distention , incidence and duration of nasogastric tube use , and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups . Time to development of bowel sounds , time to initiation of clear liquid and regular diets , and hospital stay were significantly longer in the traditional group . Major complications ( eg , pneumonia , atelectasis , and wound complications ) and febrile morbidity occurred equally in both groups . There were no known anastamotic complications or aspirations in either group . Postoperative changes in hematologic indices and electrolytes were com-parable in both groups . Conclusion Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated
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 .