Why the study?
Several medicinal treatments to avoid post-operative ileus after abdominal surgery have been evaluated in RCTs, but their relative effectiveness remained to be explored.
Do pharmacological treatments like prokinetics and opioid antagonists reduce post-operative ileus in patients undergoing abdominal surgery?
Meta-Analysis (n=6,371)
Do pharmacological treatments like prokinetics and opioid antagonists reduce post-operative ileus in patients undergoing abdominal surgery?
Prokinetics and opioid antagonists are the most consistent pharmacological treatments for reducing post-operative ileus after abdominal surgery, though neither shows clear superiority.
Supports prokinetics and opioid antagonists for faster ileus recovery after abdominal surgery; confirms and quantifies benefits across trials.
Background: Several medicinal treatments for avoiding post-operative ileus (POI) after abdominal surgery have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different treatments on ileus outcome measures. Methods: A systematic literature review was performed to identify randomised controlled trials (RCTs) comparing treatments for post-operative ileus following abdominal surgery. A Bayesian network meta-analysis was performed. Direct and indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis. Results: A total of 38 randomised controlled trials were included in this network meta-analysis reporting on 6371 patients. Our network meta-analysis shows that prokinetics significantly reduce the duration of first gas (Mean difference (MD) (hours) – 16; credible interval - 30, - 3.1; surface under the cumulative ranking curve (SUCRA) 0.418), duration of first bowel movements (Mean difference (MD) (hours) -25; credible interval - 39, - 11; SUCRA 0.25) and duration of post-operative hospitalisation (Mean difference (MD) (hours) – 1.9; credible interval – 3.8, - 0.040; SUCRA 0.34). Opioid antagonists are the only treatment that significantly improve the duration of food recovery (Mean difference (MD) (hours) - 19; credible interval - 26, - 14; SUCRA 0.163). Conclusion: Based on our meta-analysis, the two most consistent pharmacological treatments able to effectively reduce POI after abdominal surgery are prokinetics and opioid antagonists. The absence of clear superiority of one treatment over another highlights the limits of the pharmacological principles available.
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Buscail et al. (2023) conducted a meta-analysis in post-operative ileus after abdominal surgery (n=6,371). Prokinetics and opioid antagonists vs. Direct and indirect comparisons of all regimens was evaluated on duration of first gas (MD -16, 95% CI -30 to -3.1).
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