Authors: T M Drake A E Ward
Publish Date: 2016/04/12
Volume: 20, Issue: 6, Pages: 1253-1264
Abstract
Prolonged ileus is a common complication following gastrointestinal surgery with an incidence of up to 40 Investigations examining pharmacological treatment of ileus have proved largely disappointing however recently several compounds have been shown to have benefited when used as prophylaxis to prevent ileusOutcomes of time to first defecation first flatus and composite bowel recovery endpoints GI2 and GI3 were used to determine efficacy Pooled treatment effects were presented as the standard mean difference or as hazard ratios alongside the corresponding 95 confidence intervals Risk of bias was assessed using the Cochrane risk of bias frameworkA total of 17 studies were included in the final analysis The μopioid receptor antagonist alvimopan and serotonin receptor agonists appeared to significantly shorten the duration of ileus The use of Ghrelin receptor agonists did not appear to have any effect in five trials No publication bias was detectedThere is evidence to make a strong recommendation for the use of alvimopan in major gastrointestinal surgery to reduce postoperative ileus Further randomized trials are required to establish whether serotonin receptor agonists are of use Identifying a lowcost compound to promote bowel recovery following surgery could reduce complications and shorten duration of hospital admissionsNeither author has any conflicts of interest to declare This study was unfunded This work was undertaken by one of the authors TD during a period of research funded by the Royal College of Surgeons of Edinburgh and the Pathological Society Both authors contributed equally in the study conception analysis and drafting of the final manuscript Both TD and AW approved the final manuscript version prior to submissionTD has received research funding from the Royal College of Surgeons of Edinburgh The Pathological Society The Institute of Medical Ethics The British Medical Association The Wellcome Trust/Academy of Medical Sciences and The Bowel Disease Research Fund Neither individual owns stocks and shares in any company related to this article Neither individual owns any patents related to this article
Keywords: