Research status and perspective of Postoperative ileus

Postoperative gastrointestinal dysfunction and even postoperative ileus (POI) are common complications after abdominal surgery, with an incidence rate of about 10%. POI is a temporary non-mechanical cessation of gastrointestinal coordination following surgical intervention that prevents effective transport of gastrointestinal contents or tolerates oral ingestion, manifested by bloating, tenderness, and no noise of borborygmus. POI is characterized by temporary gastrointestinal motility suppression after surgical intervention due to non-mechanical causes, affecting normal diet. POI and its associated perioperative complications reduce patient comfort, prolong the length of hospital stay and significantly increase the cost of hospitalization. The etiology of POI is diverse and its pathogenesis is complex, mainly involving the release of inflammatory mediators at the injured site, inhibitory neural reflex and pharmacological mechanism. Risk factors for POI include old age, open surgery, difficult surgery, surgery longer than 3 hours, no bowel treatment before surgery, infection, or the need for blood transfusion. POI focuses on prevention, including preoperative, intraoperative and postoperative interventions. Minimally invasive surgery and multimodal analgesic therapy can reduce the incidence of POI. In the past decade, many clinical studies have explored different intervention methods to prevent the occurrence and shorten the duration of POI after surgery. Current guidelines for enhanced recovery after surgery mainly recommend minimally invasive surgery, early enteral nutrition, chewing gum, preoperative oral laxatives and alvimopan, which have certain effects on promoting postoperative gastrointestinal function recovery, reducing the occurrence of POI and shortening postoperative hospital stay.