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 .
Is early postoperative feeding feasible in elective colon and rectal surgery?
Abstract . In reports on earlier non- prospect ively r and omized trials the authors have cl aim ed that early oral postoperative feeding is a unique benefit of laparoscopic surgery . On the other h and , some authors have suggested that early feeding could be tolerated by the majority of patients after elective open surgery . Aim . This prospect i ve r and omized study was undertaken to assess the feasibility and safety of immediate oral feeding in patients subjected to elective open colorectal surgery . Methods . This trial included 190 patients who underwent an elective colon or rectal operation . Patients were r and omized after the operative procedure into one of two groups . Group I ( n = 95 ) : On the first evening after the operation , patients were allowed ab libitum intake of clear liquids ; this continued until the first postoperative day at which time they progressed to a regular diet as desired . Group II ( n = 95 ) : In this group the nasogastric tube was removed when the surgeon considered that postoperative ileus had been resolved . Results . Early oral intake was tolerated by 79.6 % of the patients in the first 4 days in group I ; there were no differences between the two groups from the 4th day on . The incidence of vomiting and nasogastric tube insertion ( 21.5 % ) was higher in patients in group I than in those in group II . The time until the first bowel movement was 4.3 days in group I and 4.7 days in group II . Complications appeared in 17.3 % of the patients in group I and in 19.3 % in group II . Conclusion : This study has objective ly demonstrated that early oral feeding is feasible and safe in patients who have elective colorectal surgery . Résumé . Des travaux r and omisés non prospect ifs ont affirmé que l'alimentation orale postopératoire précoce est un des gr and s bénéfices de la chirurgie laparoscopique . Les auteurs ont suggéré , d'autre part , une réalimentation précoce et bien tolérée par la plupart des patients après chirurgie élective ouverte . Le but de ce travail prospect if est d'établir la faisabilité et la sécurité d'une alimentation orale immédiate chez des patients ayant subi une chirurgie colo-rectale élective ouverte . Cette étude inclut 190 patients devant subir une opération colo-rectale élective . Le collectif a été r and omisé après l'intervention en deux groupes . Les patients du groupe 1 ( n = 95 ) ont été autorisés à ingurgiter des liquides ad libitum le soir de l'intervention ; au premier jour postopératoire , ils ont pus'alimenter progressivement avec un régime normal . Dans le groups 2 ( n = 95 ) la sonde naso-gastrique a été etirée lorsque le chirurgien a considéré que la phase d'iléus postopératoire s'était résolue . Résultats . La réalimentation précoce a été bien tolérée chez 79.6 % des patients au cours des 4 premiers jours du groupe 1 . Il n'y a pas de différence entre les deux groupes au 4e jour . L'incidence des vomissements et la nécessité de replacer une sonde nasogastrique ( 21,5 % ) est plus élevée dans le groupe 1 que dans le groupe 2 . La première exonération s'est produite au 4,3e jour dans le groupe 1 et au 4,7e jour dans le groupe 2 . Des complications sont apparues chez 17,3 % des patients du groupe 1 et 19,3 % des patients du groupe 2 . En conclusion , cette étude a démontré de manière objective que la réalimentation orale précoce est possible et sûre chez des patients soumis à une chirurgie colo-rectale élective
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 .