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. 2017 Feb;402(1):149-158.
doi: 10.1007/s00423-016-1485-1. Epub 2016 Aug 3.

Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment

Daniel Gero  1 , Olivier Gié  1 , Martin Hübner  1 , Nicolas Demartines  1 , Dieter Hahnloser  2
Affiliations

Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment

Daniel Gero et al. Langenbecks Arch Surg. 2017 Feb.

Abstract

Purpose: Postoperative ileus (POI) is a frequent complication after abdominal surgery; nonetheless, it remains poorly defined. Our aim was to achieve an international consensus among leading colorectal surgeons on definition, prevention, and treatment of POI.

Methods: Thirty-five experts from five continents participated in a three-round Delphi process. Round 1 contained open-ended questions on POI and postoperative nausea and vomiting (PONV). Round 2 included closed-ended questions. Round 3 measured agreement on a 5-point Likert scale. Consensus was defined when items were rated as agree or strongly agree by at least 70 % of the experts.

Results: Experts reached following consensus: POI is a temporary inhibition (86 %) of gastrointestinal motility after surgical intervention due to non-mechanical causes (89 %) and prevents sufficient oral intake (96 %). Abdominal distension/tenderness are the most relevant clinical signs (71 %). Nasogastric tube placement is not mandatory (78 %) but can be removed without previous clamping (81 %)/gastrointestinal contrast study (100 %). Preventive measures are recommended to decrease the risk of POI (96 %): narcotic sparing analgesia (89 %) and fluid optimization (74 %). Treatment of POI should include stimulation of ambulation (96 %) and stop of opioids (74 %). Total parenteral nutrition is recommended from the 7th day without sufficient oral intake (81 %). There was no consensus on the ranking of POI's symptoms, on the imaging modality of choice for the diagnosis of POI, neither on the difference between POI and PONV.

Conclusions: This Delphi study achieved consensus on the definition, relevant clinical signs, prevention, treatment, and supportive care of POI. Areas of non-consensus were identified (necessity and modality of radiologic imaging to establish the diagnosis, difference between POI and PONV), giving opportunity for further research.

Keywords: Consensus; Delphi method; Ileus; PONV; Postoperative ileus; Postoperative nausea and vomiting.

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