Key result
Colonic mechanical preparation with oral antibiotics reduces postoperative ileus while open surgery increases rates.
Why the study?
Postoperative ileus is a common problem after colorectal surgery, motivating an investigation into strategies outside enhanced recovery after surgery principles to reduce it.
Do specific surgical and medical strategies reduce postoperative ileus in patients undergoing colorectal surgery?
Systematic Review
Do specific surgical and medical strategies reduce postoperative ileus in patients undergoing colorectal surgery?
Colonic mechanical preparation with oral antibiotics and minimally invasive surgical approaches (robotic/laparoscopic) are associated with reduced rates of postoperative ileus in colorectal surgery.
Supports combined mechanical prep plus oral antibiotics and minimally invasive approaches to reduce ileus; strengthens pooled evidence in colorectal surgery.
Postoperative ileus (PI) after colorectal surgery is a common surgical problem. This systematic review aimed to investigate the available data in the literature to reduce the PI in the area of colorectal surgery out of the enhanced recovery after surgery principles, referring to published randomized controlled trials (RCTs) and meta-analyses, and to provide recommendations according to the Oxford Centre for Evidence-Based Medicine. The authors conducted bibliographic research on 1 December 2022. The authors retained meta-analyses and RCTs. The authors concluded that when we combined colonic mechanical preparation with oral antibiotic decontamination, the authors found a significant reduction in PI. The open approach was associated with a higher PI rate. The robotic and laparoscopic approaches had similar PI rates. Low ligation of the inferior mesenteric artery presented a PI similar to that of high ligation of the inferior mesenteric artery. There was no difference between the isoperistaltic and antiperistaltic anastomoses or between the intracorporeal and extracorporeal anastomoses. This study summarized the available data in the literature, including meta-analyses and RCTs. For a higher level of evidence, additional multicenter RCTs and meta-analyses of RCTs remain necessary.
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Chaouch et al. (2023) conducted a systematic review in Postoperative ileus after colorectal surgery. Colonic mechanical preparation with oral antibiotic decontamination and minimally invasive surgical approaches vs. Standard care or open surgical approaches was evaluated on Postoperative ileus (PI) rate. Combining colonic mechanical preparation with oral antibiotic decontamination significantly reduced postoperative ileus, whereas open surgical approaches were associated with higher rates.
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