INTRODUCTION
Post-operative ileus is a common condition occurring after abdominal
surgery and reflects a slowing or complete cessation of bowel
motility1. This complication is common and variable
among series, affecting between 10 and 25% of patients after abdominal
surgery2. The costs associated with post-operative
ileus are considerable. In the United States, the total annual cost of
care for all hospitalisations related to paralytic ileus increased from
$7.1 billion in 2001 to $12.3 billion in 20113.
Post-operative ileus (POI) induces its own morbidity and prolongs
hospital length of stay. Pathophysiologic studies have identified at
least two phases in post-operative ileus, an early phase involving
neural pathways known as the ”neurogenic phase” and a later phase which
is characterised by inflammatory features4. Since the
end of the 1970s, numerous clinical trials have been set up to evaluate
the efficacy of different pharmacological treatments targeting
inflammation, gastric movement or microbiota. Based on the variety of
treatments and definitions of ileus in current clinical practice, it
seemed necessary to compare the various pharmacological approaches used
in the treatment of ileus5. A network approach using
hierarchical Bayesian models allows indirect comparisons of
pharmacological therapies for ileus after abdominal surgery and produces
previously unexplored relative effectiveness. We conducted a systematic
review identifying all randomised controlled trials evaluating
pharmacological interventions to treat post-operative ileus after
abdominal surgery5. After identifying the studies, we
performed a networked meta-analysis of all available high-quality trials
to provide new evidence in favour of pharmacological treatments to
reduce ileus.