Preventive Measures to Minimize or Avoid Postoperative Ileus

Since the pathogenesis of postoperative ileus (POI) is multifactorial and includes activation of inhibitory neural reflexes, inflammatory mediators, and opioids, preventive and therapeutic strategies are also multiple and include continuous thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists or opioid-sparing analgesic techniques, laparoscopic surgery, avoidance of routine use of nasogastric tubes, and fluid excess. The role of laxatives is unclear and requires further study. When these techniques are combined in multimodal rehabilitation programs (fast-track surgery) duration of POI can be reduced to 1 to 2 days in most patients after colorectal surgery. (C) 2005 Elsevier Inc. All rights reserved.