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 .
Must early postoperative oral intake be limited to laparoscopy?
PURPOSE : This prospect i ve , r and omized study was design ed to evaluate whether or not early postoperative feeding ( cl aim ed as a unique benefit of laparoscopic surgery ) is possible after laparotomy and colorectal resection . METHODS : The trial was performed between July 1 , 1992 and October 31 , 1992 and included all 64 consecutive patients who underwent laparotomy with either a colonic or an ileal resection .  In all cases the nasogastric tube was removed immediately after the operation . Group 1 consisted of 32 patients ( age range , 15–81 years ; mean , 52 years ) who received a regular diet on the first postoperative morning . Group 2 consisted of 32 patients ( age range , 15–87 years ; mean , 52 years ) who were fed in a traditional manner .  Regular food was permitted after resolution of ileus as defined by resumption of bowel movements in the absence of abdominal distention , nausea , or vomiting . RESULTS : The rate of nasogastric tube reinsertion for distention with persistent vomiting was 18.7 percent ( six patients ) in Group 1 and 12.5 percent ( four patients ) in Group 2 . Although vomiting was experienced more frequently by patients in Group 1 ( 44 percentvs.25 percent , respectively ) , there was no difference between the two groups with regard to the duration of postoperative ileus ( 3.6vs.3.4 days , respectively ) . In the 26 patients from Group 1 who did not require nasogastric tube reinsertion , there was a trend toward shorter hospitalization ( 6.7vs.8.0 days , respectively ) . CONCLUSION : Early oral intake is possible after laparotomy and colorectal resection . Thus , the laparoscopic surgeon 's cl aim of early tolerated oral intake may not be unique to laparoscopy
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 .