Dietary Interventions for the Reduction of Postoperative Ileus Following Abdominal Surgery: A Literature Review
Postoperative Ileus Dietary Interventions
Keywords:Ileus, Dietary Care post-Operative
Introduction: A postoperative ileus (POI) is a common complication in patients following abdominal surgery which slows patient recovery and increases postoperative morbidity, length of hospital stay, resource use and healthcare costs. Although many interventions have been hypothesized to play a role in the prevention and management of POI, including chewing gum, coffee, and early enteral feeding, current guidelines regarding best clinical practice are lacking. Objective: The efficacy and safety of various dietary interventions used in the reduction of POI, to aid in providing evidence-based recommendations for future Canadian guidelines on this topic. Chewing gum, coffee, and early enteral feeding was examined. Methods: This literature review used the PubMed database. The primary outcomes measured were the effectiveness of each intervention in lowering the incidence of an ileus as well as their overall safety. Results: Four of eight studies identified positive benefits from the addition of chewing gum on bowel recovery. Three primary studies identified that coffee is beneficial in reducing time to first bowel movement. Three of four studies showed that early enteral feeding significantly improves gastrointestinal motility. All studies reviewed agreed that their respective interventional measures are safe and are not associated with an increase in postoperative complications. Conclusion: Although none of the interventions reviewed show complete consensus regarding their ability to reduce POI, there is an agreement that these measures are safe, well-tolerated, and not related to any major adverse effects. Therefore, chewing gum, coffee, and early enteral feeding are all postoperative measures that patients can be encouraged to adopt. The exact combination of these methods which should be included in the guidelines is unknown and requires further studies to examine the additional benefits provided by using more than one intervention.
Kalff JC, Wehner S, Litkouhi B. Postoperative ileus [Internet]. UpToDate. 2019. Available from: https://www.uptodate.com/contents/postoperative-ileus?search=postoperative ileus&source=search_result&selectedTitle=1~56&usage_type=default&display_rank=1
Stakenborg N, Gomez-Pinilla PJ, Boeckxstaens GE. Postoperative ileus: Pathophysiology, current therapeutic approaches. Handb Exp Pharmacol. 2016 Jan 1;239:39–57.
Barclay KL, Zhu YY, Tacey MA. Nausea, vomiting and return of bowel function after colorectal surgery. ANZ J Surg. 2015 Nov 1;85(11):823–8.
Vather R, Trivedi S, Bissett I. Defining Postoperative Ileus: Results of a Systematic Review and Global Survey. Vol. 17, Journal of Gastrointestinal Surgery. 2013. p. 962–72.
Goldstein JL, Matuszewski KA, Delaney CP, Senagore A, Chiao EF, Shah M, et al. Inpatient Economic Burden of Postoperative Ileus Associated with Abdominal Surgery in the United States [Internet]. Vol. 32. 2007. Available from: https://www.researchgate.net/publication/265399177
Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. Vol. 153, Journal of Visceral Surgery. Elsevier Masson SAS; 2016. p. 439–46.
Venara A, Meillat H, Cotte E, Ouaissi M, Duchalais E, Mor-Martinez C, et al. Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis. World J Surg. 2020 Mar 1;44:957–66.
Wolthuis AM, Bislenghi G, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D’Hoore A. Incidence of prolonged postoperative ileus after colorectal surgery: A systematic review and meta-analysis. Vol. 18, Colorectal Disease. Blackwell Publishing Ltd; 2015. p. O1–9.
Alhashemi M, Fiore JF, Safa N, Al Mahroos M, Mata J, Pecorelli N, et al. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway. Surg Endosc. 2019 Jul 15;33(7):2313–22.
Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus. World J Surg. 2006;30(8):1382–91.
Topcu SY, Oztekin SD. Effect of gum chewing on reducing postoperative ileus and recovery after colorectal surgery: A randomised controlled trial. Complement Ther Clin Pract [Internet]. 2016;23:21–5. Available from: http://dx.doi.org/10.1016/j.ctcp.2016.02.001
Van Den Heijkant TC, Costes LMM, Van Der Lee DGC, Aerts B, Osinga-De Jong M, Rutten HRM, et al. Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. Br J Surg. 2015;102(3):202–11.
Shum NF, Choi HK, Mak JCK, Foo DCC, Li WC, Law WL. Randomized clinical trial of chewing gum after laparoscopic colorectal resection. Br J Surg. 2016;103(11):1447–52.
de Leede EM, van Leersum NJ, Kroon HM, van Weel V, van der Sijp JRM, Bonsing BA. Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery. Br J Surg. 2018;105(7):820–8.
Forrester DAT, Doyle-Munoz J, McTigue T, Dandrea S, Natale-Ryan A. The efficacy of gum chewing in reducing postoperative ileus: A multisite randomized controlled trial. J Wound, Ostomy Cont Nurs. 2014;41(3):227–32.
Atkinson C, Penfold CM, Ness AR, Longman RJ, Thomas SJ, Hollingworth W, et al. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg. 2016;103(8):962–70.
Zaghiyan K, Felder S, Ovsepyan G, Murrell Z, Sokol T, Moore B, et al. A prospective randomized controlled trial of sugared chewing gum on gastrointestinal recovery after major colorectal surgery in patients managed with early enteral feeding. Dis Colon Rectum. 2013;56(3):328–35.
Liu Q, Jiang H, Xu D, Jin J. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials. Int J Surg [Internet]. 2017;47:107–15. Available from: https://doi.org/10.1016/j.ijsu.2017.07.107
Müller SA, Rahbari NN, Schneider F, Warschkow R, Simon T, Von Frankenberg M, et al. Randomized clinical trial on the effect of coffee on postoperative ileus following elective colectomy. Br J Surg. 2012 Nov;99(11):1530–8.
Dulskas A, Klimovskij M, Vitkauskiene M, Samalavicius NE. Effect of coffee on the length of postoperative ileus after elective laparoscopic left-sided colectomy: A randomized, prospective single-center study. Dis Colon Rectum. 2015;58(11):1064–9.
Hasler-Gehrer S, Linecker M, Keerl A, Slieker J, Descloux A, Rosenberg R, et al. Does Coffee Intake Reduce Postoperative Ileus after Laparoscopic Elective Colorectal Surgery? A Prospective, Randomized Controlled Study: The Coffee Study. Dis Colon Rectum. 2019;62(8):997–1004.
Pragatheeswarane M, Muthukumarassamy R, Kadambari D, Kate V. Early Oral Feeding vs. Traditional Feeding in Patients Undergoing Elective Open Bowel Surgery-a Randomized Controlled Trial. J Gastrointest Surg. 2014;18(5):1017–23.
Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics. 2011;66(12):2001–5.
Boelens PG, Heesakkers FFBM, Luyer MDP, Van Barneveld KWY, De Hingh IHJT, Nieuwenhuijzen GAP, et al. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: Prospective, randomized, controlled trial. Ann Surg. 2014;259(4):649–55.
Osland E, Yunus RM, Khan S, Memon MA. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery:a meta-analysis. J Parenter Enter Nutr. 2011;35(4):473–87.
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