Non-Pharmacological Treatments
There are several risk factors for postoperative ileus, however many of those identified in studies cannot be modified. Chapuis et al . conducted an observational study involving 2,400 patients undergoing colorectal cancer surgery. The independent predictors of POI were male gender, peripheral vascular history, history of respiratory pathology, emergency surgery, intraoperative transfusion, stoma placement and surgical procedure of over 3 hours’ duration (Chapuis et al., 2013).
Numerous publications have shown the effectiveness of early rehabilitation measures on the post-operative course of abdominal surgery and on intestinal motility in particular (Vlug et al., 2011). The non-pharmacological measures used in these rehabilitation schemes, widely described in the literature, are not discussed in this paper. The broad outlines of these strategies can be described as a ”simplification” of patient management. Firstly, there is no routine placement of a nasogastric tube because prophylactic emptying of the stomach has not highlighted any improvement in transit recovery (Vlug et al., 2012). This equipment allows the patient to be mobilised early, which is also a factor in the recovery of gut motility (Vlug et al., 2011). Another important aspect is the monitoring of the balanced fluid state in order to prevent visceral oedema that increases the risk of POI and anastomotic leakage (Shah et al., 2011). Finally, as shown in the LAFA trial involving 400 post-colectomy patients, the laparoscopic approach allows a median return to tolerate food one day earlier and a faster discharge from hospital with a median reduction of 1 day in the length of stay (Vlug et al., 2011).