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 removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy.
AIM To evaluate the feasibility , safety , and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma . METHODS Three hundred and sixteen patients su bmi tted to operations associated with colorectostomy from January 2004 to September 2005 were r and omized to two groups : In experimental group ( n=161 ) , the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding ; In control group ( n=155 ) , the nasogastric tube was maintained until the passage of flatus per rectum . Variables assessed included the time to first passage of flatus , the time to first passage of stool , the time elapsed postoperative stay , and postoperative complications such as anastomotic leakage , acute dilation of stomach , wound infection and dehiscense , fever , pulmonary infection and pharyngolaryngitis . RESULTS The median and average days to the first passage of flatus ( 3.0+/-0.9 vs 3.6+/-1.2 , P<0.001 ) , the first passage of stool ( 4.1+/-1.1 vs 4.8+/-1.4 , P<0.001 ) and the length of postoperative stay ( 8.4+/-3.4 vs 9.6+/-5.0 , P<0.05 ) were shorter in the experimental group than in the control group . The postoperative complications such as anastomotic leakage ( 1.24 % vs 2.58 % ) , acute dilation of stomach ( 1.86 % vs 0.06 % ) and wound complications ( 2.48 % vs 1.94 % ) were similar in the groups , but fever ( 3.73 % vs 9.68 % , P<0.05 ) , pulmonary infection ( 0.62 % vs 4.52 % , P<0.05 ) and pharyngolaryngitis ( 3.11 % vs 23.23 % , P<0.001 ) were much more in the control group than in the experimental group . CONCLUSION The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications . On the contrary , it may increase the incidence rate of fever , pharyngolaryngitis and pulmonary infection . These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation
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 .