Strategies to reduce ileus after colorectal surgery: A qualitative umbrella review of the collective evidence.
Study Goal
The researchers aimed to evaluate the effectiveness of chewing gum in reducing postoperative ileus and accelerating bowel function recovery after colorectal surgery.
Results Summary
Chewing gum was associated with a median reduction of postoperative ileus by 45% and shortened the time to first flatus by 11.9 hours and time to defecation by 17.7 hours. It was one of the most assessed and effective interventions for improving bowel function recovery.
Population
Patients undergoing colorectal surgery.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
early oral feeding | decrease | postoperative ileus | patients after colorectal surgery | - | reduced | #1 |
early oral feeding | increase | bowel function return | patients after colorectal surgery | - | accelerated | #2 |
chewing gum | decrease | postoperative ileus | patients after colorectal surgery | 45% (range, 11%-59%) | associated with a median reduction of | #3 |
chewing gum | decrease | time to first flatus | patients after colorectal surgery | median of 11.9 hours | shortening of | #4 |
chewing gum | decrease | time to defecation | patients after colorectal surgery | median of 17.7 hours | shortening of | #5 |
coffee intake | no change | postoperative ileus | patients after colorectal surgery | - | showed inconsistent results | #6 |
coffee intake | decrease | time to flatus | patients after colorectal surgery | median of 1.32 hours | shortening of | #7 |
coffee intake | decrease | time to defecation | patients after colorectal surgery | median of 14.45 hours | shortening of | #8 |
alvimopan | decrease | postoperative ileus | patients after colorectal surgery | - | effective strategies for reducing | #9 |
intravenous dexamethasone | increase | bowel function return | patients after colorectal surgery | - | helped hasten | #10 |
intravenous lidocaine | increase | bowel function return | patients after colorectal surgery | - | helped hasten | #11 |
oral probiotics | increase | bowel function return | patients after colorectal surgery | - | helped hasten | #12 |
acupuncture | increase | recovery of bowel function | patients after colorectal surgery | - | positively impacted | #13 |
BACKGROUND: Various strategies were proposed to reduce postoperative ileus after colorectal surgery. This umbrella review aimed to provide a comprehensive overview of current evidence on measures to reduce the incidence and severity of postoperative ileus after colorectal surgery. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic search was conducted in PubMed and Scopus to identify systematic reviews that assessed the efficacy of interventions used to prevent postoperative ileus after colorectal surgery. Data on study characteristics, interventions, and outcomes were summarized in a narrative manner. RESULTS: A total of 26 systematic reviews incorporating various strategies like early oral feeding, gum chewing, coffee consumption, medications, and acupuncture were included. Early oral feeding reduced postoperative ileus and accelerated bowel function return. The most assessed intervention was chewing gum, which was associated with a median reduction of postoperative ileus by 45% (range, 11%-59%) and shortening of the time to first flatus and time to defecation by a median of 11.9 and 17.7 hours, respectively. Coffee intake showed inconsistent results, with a median shortening of time to flatus and time to defecation by 1.32 and 14.45 hours, respectively. CONCLUSION: Early oral feeding, chewing gum, and alvimopan were the most commonly assessed and effective strategies for reducing postoperative ileus after colorectal surgery. Medications used to reduce postoperative ileus included alvimopan, intravenous lidocaine, dexamethasone, probiotics, and oral antibiotics. Intravenous dexamethasone and lidocaine and oral probiotics helped hasten bowel function return. Acupuncture positively impacted the recovery of bowel function.