From the Guidelines
The treatment for ileus primarily involves a multifaceted approach to minimize postoperative ileus, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Initial management includes bowel rest, intravenous fluid administration to maintain hydration and electrolyte balance, and nasogastric tube placement to decompress the stomach and prevent vomiting.
- Pain management is important, preferably using non-opioid medications since opioids can worsen ileus.
- Early ambulation is encouraged as movement helps stimulate bowel function.
- In some cases, medications like metoclopramide, erythromycin, or alvimopan may be used to promote gastrointestinal motility.
- Underlying causes such as electrolyte abnormalities (particularly potassium, magnesium, and calcium) should be corrected.
- Nutrition support via parenteral nutrition may be needed if ileus persists beyond 5-7 days.
- Surgery is rarely required but may be necessary if there is an underlying mechanical obstruction or if conservative management fails.
Prevention of Postoperative Ileus
- Mid-thoracic epidural analgesia as compared with intravenous opioid analgesia is highly effective at preventing postoperative ileus 1.
- Fluid overloading during and after surgery impairs gastrointestinal function and should be avoided.
- Avoidance of nasogastric decompression may reduce the duration of postoperative ileus.
- Laparoscopic-assisted colonic resection leads to faster return of bowel function, as well as resumption of an oral diet, compared with open surgery.
- Oral magnesium oxide and bisacodyl have been shown to promote postoperative bowel function in some studies 1.
- Alvimopan given via the oral route accelerates gastrointestinal recovery and reduces the length of stay in patients undergoing open colonic resection having postoperative opioid analgesia 1.
- Perioperative use of chewing gum has a positive effect on postoperative duration of ileus 1.
From the Research
Treatment for Ileus
The treatment for ileus typically involves addressing the underlying cause and providing supportive care. According to 2, management includes:
- Addressing the underlying cause
- Supportive care
- Medical interventions, although their effectiveness is uncertain
Medical Interventions
Several medical interventions have been proposed to treat ileus, including:
- Metoclopramide: however, 2 found that metoclopramide was not effective in expediting the resolution of ileus
- Erythromycin: 2 also found that erythromycin was not effective in expediting the resolution of ileus
- Early enteral nutrition (EEN): 2 strongly recommends EEN to expedite resolution of ileus in patients who have undergone abdominal surgery
- Neostigmine: 3 found that neostigmine was effective in treating postoperative ileus in orthopedic spinal patients, and 4 found that ST36 acupoint injection with neostigmine was safe and effective for treatment of paralytic postoperative ileus
Other Factors
Other factors that can influence the development and treatment of ileus include:
- Neuromuscular reversal agents: 5 found that sugammadex was associated with a reduced time to achieving first stool and GI-2 compared to neostigmine/glycopyrrolate
- Opioid use: 5 found that increased postoperative opioid use was associated with delayed time to achieving GI-2
- Smoking history: 5 found that smoking history was associated with postoperative ileus
- Previous abdominal surgery: 5 found that previous abdominal surgery was associated with postoperative ileus
- Colostomy formation: 5 found that colostomy formation was associated with postoperative ileus
- Postoperative hypokalaemia: 5 found that postoperative hypokalaemia was associated with postoperative ileus
Acupoint Injection
Acupoint injection with neostigmine has been found to be effective in treating paralytic postoperative ileus, with 4 finding that ST36 acupoint injection with neostigmine was safe and effective for treatment of PPOI.