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 postoperative feeding after elective colorectal surgery.
BACKGROUND Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated , and 1 recent study demonstrated the safety of early oral feedings . OBJECTIVE To test the hypothesis that successful early feeding would lead to a shorter duration of hospitalization and , therefore , would be more cost-effective . PATIENTS Fifty-eight patients with elective colorectal surgery . METHODS Patients were prospect ively r and omized to 1 of 2 postoperative treatment arms : early feeding ( EF group , n = 29 ) and traditional feeding ( TF group , n = 29 ) . All patients in the EF group began a liquid diet on the first postoperative day and were advanced to a regular diet when they consumed 1000 mL in 24 hours . All patients in the TF group began a liquid diet after resolution of the postoperative ileus and were advanced to a regular diet after consuming 1000 mL in 24 hours . Patients were dismissed after tolerating two thirds of the regular diet . Both groups had intraoperative orogastric tubes that were removed at the end of surgery . Nasogastric tubes were inserted for persistent postoperative vomiting . RESULTS No significant differences were noted in age , types of procedures , or in prior abdominal surgery in either group . No significant differences were seen in rates of nausea ( 55 % in EF vs 50 % in TF group ) or vomiting ( 48 % in EF vs 33 % in TF group ) . One patient in the EF group had aspiration pneumonia , and anastomotic leak result ed in sepsis and eventual death of 1 patient in the TF group . No significant difference was observed in length of hospital stay between the 2 groups ( mean + /- SD , 7.2 + /- 3.3 days in EF vs 8.1 + /- 2.3 days in TF group ) . CONCLUSIONS Early oral feeding after elective colorectal surgery is safe . Most of the patients tolerated EF ; however , there was no significant difference in duration of hospitalization in these patients
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 .