Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. A multicenter, randomized, double-blind, placebo-controlled trial of the prokinetic agent erythromycin in the postoperative recovery of infants with gastroschisis. Anaesthetic technique does not influence postoperative bowel function: a comparison of propofol, nitrous oxide and isoflurane Effect of intravenous erythromycin on postoperative ileus. Does metoclopramide reduce the length of ileus after colorectal surgery? Management of postoperative ileus: focus on alvimopan Does enhanced recovery reduce postoperative ileus after colorectal surgery? The duration of postoperative ileus after elective colectomy is correlated to surgical specialization Erythromycin reduces delayed gastric emptying in critically ill trauma patients: a randomized, controlled trial. The gastrointestinal safety of the COX-2 selective inhibitor etoricoxib assessed by both endoscopy and analysis of upper gastrointestinal events Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial Preoperative Probiotics Decrease Postoperative Infectious Complications of Colorectal Cancer Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Prokinetic effect of erythromycin after colorectal surgery Early postoperative administration of probiotics versus placebo in elderly patients undergoing elective colorectal surgery: a double-blind randomized controlled trial
OBJECTIVES Treatment of postoperative ileus remains unsatisfactory . Erythromycin ( EM ) , a macrolide antibiotic , has prokinetic effects on the gut . We investigated whether intravenous erythromycin decreases the time to the return of normal bowel function after bowel surgery in patients with bladder cancer and interstitial cystitis who have undergone cystectomy and urinary diversion . METHODS We conducted a double-blind , r and omized , placebo-controlled study of 22 volunteers . On the first postoperative day , patients began receiving intravenous erythromycin ( 125 mg ) or placebo every 8 hours ( maximum of 21 doses ) . The patients ' ability to tolerate a general diet and return of bowel function was monitored . RESULTS A general diet was tolerated at a median of 9 days postoperatively for the EM arm and 8 for the placebo arm ( P = 0.60 ) . The first bowel sounds were detected at an average of 2 postoperative days for the EM arm and 3 for the placebo arm ( P = 0.88 ) . First flatus was present an average of 5 days postoperatively for both study arms ( P = 0.35 ) . The first bowel movement was present an average of 6 days postoperatively for the EM arm and 5 for the placebo arm ( P = 0.98 ) . CONCLUSIONS No significant difference was found between EM and placebo with regard to the onset of bowel sounds , passage of flatus , passage of the first bowel movement , and the time to tolerate a general diet . These data indicate that erythromycin is not useful in improving postoperative bowel function PURPOSE Cardiovascular optimization via esophageal Doppler can minimize gastrointestinal hypoperfusion , reducing the risk of multiple organ dysfunction and postoperative complications during major surgery . We assessed the effect of esophageal Doppler guided cardiovascular optimization in patients undergoing radical cystectomy . MATERIAL S AND METHODS We conducted a prospect i ve , r and omized , double-blind controlled trial at a United Kingdom teaching hospital between 2006 and 2009 . A total of 66 patients were r and omized to a control arm ( 34 ) and an intervention arm ( 32 ) . The control group received st and ard intraoperative fluids . The intervention group received ( additional ) Doppler guided fluid . Primary outcomes were markers of gastrointestinal morbidity such as ileus , flatus and bowel opening . Secondary outcomes were postoperative nausea and vomiting , wound infection and operative intravenous fluid volumes ( total and hourly ) . RESULTS There were significant reductions in the control and intervention arms in the incidence of ileus ( 18 vs 7 , p < 0.001 ) , flatus ( 5.36 vs 3.55 days , p < 0.01 ) and bowel opening ( 9.79 vs 6.53 days , p = 0.02 ) , respectively . Nausea and vomiting were significantly reduced in the study group at 24 and 48 hours postoperatively ( 11 vs 3 , p < 0.01 and 13 vs 1 , p < 0.0001 ) . Wound infection rates were significantly reduced ( 8 vs 1 superficial , p < 0.01 and 10 vs 2 combined , p < 0.01 ) . Study patients received significantly higher volumes ( ml/kg per minute ) of intravenous fluid ( 0.19 vs 0.23 , p < 0.01 ) related to a significantly higher volume ( ml/kg ) in the first hour of surgery ( 14.1 vs 21.0 , p = 0.0001 ) . CONCLUSIONS Cardiovascular optimization using esophageal Doppler significantly improved postoperative markers of gastrointestinal function OBJECTIVE To investigate the efficacy and safety of alvimopan , 12 mg , administered orally 30 to 90 minutes preoperatively and twice daily postoperatively in conjunction with a st and ardized accelerated postoperative care pathway for managing postoperative ileus after bowel resection . DESIGN , SETTING , AND PATIENTS This multicenter , r and omized , placebo-controlled , double-blind , phase 3 trial enrolled adult patients undergoing partial bowel resection with primary anastomosis by laparotomy and scheduled to receive intravenous , opioid-based , patient-controlled analgesia .  A st and ardized accelerated postoperative care pathway including early ambulation , oral feeding , and postoperative nasogastric tube removal was used to facilitate gastrointestinal ( GI ) tract recovery in all of the patients . MAIN OUTCOME MEASURES The primary end point was time to GI-2 recovery ( toleration of solid food and first bowel movement ) . Secondary end points included time to GI-3 recovery ( toleration of solid food and first flatus or bowel movement ) , hospital discharge order written , and actual hospital discharge . Postoperative length of hospital stay based on calendar day of hospital discharge order written , opioid consumption , and overall postoperative ileus-related morbidity were recorded . RESULTS Alvimopan , 12 mg , was well tolerated and significantly accelerated GI-2 recovery , GI-3 recovery , and actual hospital discharge compared with a st and ardized accelerated postoperative care pathway alone ( hazard ratio = 1.5 , 1.5 , and 1.4 , respectively ; P < .001 for all ) . Time to hospital discharge order written as measured by hazard ratio ( 1.4 ) and by postoperative calendar days ( mean for alvimopan , 5.2 days ; mean for placebo , 6.2 days ) was also accelerated . Opioid consumption was comparable between groups , and alvimopan was associated with reduced postoperative ileus-related morbidity compared with placebo . CONCLUSIONS Alvimopan , 12 mg , administered 30 to 90 minutes before and twice daily after bowel resection is well tolerated , accelerates GI tract recovery , and reduces postoperative ileus-related morbidity without compromising opioid analgesia BACKGROUND / PURPOSE The recovery of gut function after repair of gastroschisis is frequently prolonged , and these infants are prone to complications associated with parenteral nutrition . This trial was design ed to investigate the effect of the prokinetic agent , erythromycin , on the attainment of full enteral feeding in infants after primary repair of uncomplicated gastroschisis . METHODS A multicenter , r and omized , double-blind , placebo-controlled trial was used to investigate the effect of enteral erythromycin ( 3 mg/kg/dose 4 times daily ) compared with placebo on the attainment of full enteral feeding tolerance after primary repair of uncomplicated gastroschisis . Eleven neonatal surgical units in the United Kingdom participated in the study . The primary end-point was the time taken to achieve continuous enteral feeding at 150 mL/kg/24 hours sustained for 48 hours . RESULTS Of 70 eligible infants , 62 were recruited and r and omly divided . There were 30 patients in group I ( placebo ) and 32 in group II ( erythromycin ) . The groups were comparable in terms of mean gestational age , mean birth weight , extent of evisceration , and degree of intestinal peel . There was no statistically significant difference between the 2 groups in the time taken to achieve full enteral feeding ( 27.2 v 28.7 days ; P = .75 ) . Similarly , no significant differences were found in the incidence of catheter-related sepsis , duration of parenteral nutrition , or time to discharge between the 2 groups . CONCLUSIONS Enterally administered erythromycin at a dose of 3 mg/kg 4 times daily conferred no advantage in the time taken to achieve full enteral feeding after primary repair of uncomplicated gastroschisis The aim of this study was to evaluate the influence of propofol , nitrous oxide and isoflurane on recovery , postoperative bowel function and postoperative complications after major gastrointestinal surgery . Sixty patients undergoing elective colonic operations were included in the study . They were r and omly allocated to anaesthesia with isoflurane- nitrous oxide , propofolair , or propofol-nitrous oxide , with fentanyl and vecuronium being used in all three groups . The same anaesthetic and surgical teams performed all the operations . The postoperative course was judged once each day by the Acute Physiology Score ( APS ) based on the Apache II classification , passage of gas , tolerance of enteral feeding , hospital stay and complications up to 30 days after surgery . The demographic data , magnitude of operation , duration of operation , intraoperative blood loss , and post-operative analgesic needs were similar in the groups . In all groups the APS was normal by median day I ( range 1–7 ) . A similar impairment of bowel function after operation , with passage of gas median 3 ( 1–6 ) days after surgery and tolerance of enteral intake median day 5 ( 1–10 ) , was found in all groups . The incidence of complications and the length of postoperative hospital stay , median 11 ( 6–45 ) days , did not differ among the groups . It is concluded that overall recovery , bowel function , postoperative hospital stay , and complications were not influenced by the anaesthetic technique . RésuméL’objectif de cette étude est d’évaluer l’influence du propofol , du protoxyde d’azote et de l’isoflurane sur la rétablissement , l’activité intestinale et les complications après une chirurgie gastro- intestinale majeure . L’étude inclut soixante patients subissant une intervention non urgente sur le colon . Ils sont distribués de façon aléatoire en trois groupes : isofluraneprotoxyde , propofol- air , propofol- protoxyde . Pour supplémenter , les trois groupes reçoivent du fentanyl et du vécuronium . Un seul anesthésiste et une seule équipe chirurgicale réalisent troutes les interventions . L’évolution postopératoire est cotée quotidiennement sur Viéhelle physiologique APS dérivée de la classification Apache II , sur le passage de gaz , la tolérance de l’alimentation orale , la durée du séjour hospitalier et les complications postopératoires apparaissant avant 30 jours . Les données démographiques , la durée de l’intervention , les pertes sanguines peropératoires et les besoins analgésiques postopératoires sont indentiques pour tous les groupes . Les résultats montrent que pour chacun des groupes , l’échelle APS se normalise entre 1 et 7 jours ( médiane 1 ) . La dysfunction intestinale est aussi la même après Vopération alors que le passage des gaz reprend entre 1 et 6 jours ( médiane 3 ) et le retour à l’alimentation orale entre 1 et 10 jours ( mediane 5 ) . Vincidence des complications et la duree du séjours postopératoire ( 6– 45 jours : médiane 11 ) sont identiques pour les trois groups . On peut conclure que la récupération , la fonction intestinale et l’incidence des complications ne subissent pas l’influence de la technique anesthésique We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospect i ve , double-blind , placebo-controlled study . Seventy-seven patients were r and omized and included in the statistical calculations . The patients were stratified according to the operation performed ( cholecystectomy , celiotomy , or other major abdominal operations ) . Forty-one patients ( group 1 ) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room . Thirty-six patients ( group 2 ) received placebo . The time ( in hours ) to first passage of flatus , first liquid meal , first bowel movement , and total length of hospital stay was recorded . There was no significant difference between group 1 and group 2 in time to first flatus ( 54.9 + /- 29 vs. 53.9 + /- 27 h , respectively ) , first meal ( 70.4 + /- 44 vs. 71.7 + /- 65 ) , first bowel movement ( 81.8 + /- 32 vs. 80.1 + /- 28 ) , or length of hospital stay ( 185.2 + /- 183 vs. 182.1 + /- 163 ) . Erythromycin , in the dosage tested in this study , does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation . New prokinetic agents may deserve further studies Between August 1988 and September 1989 , 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospect ively r and omized to receive or not to receive metoclopramide . Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated . Seven patients were not included in the final tabulations because of one death , one small bowel obstruction requiring laparotomy , one anastomotic leak requiring laparotomy , and four protocol violations . Ninety-three patients , 37 men and 56 women ( mean age , 59.5 ; range , 14–89 years ) underwent 40 segmental colectomies , 13 total abdominal colectomies , 8 abdominoperineal resections , 8 ileoanal pouch procedures , 7 small bowel resections , and 17 other colorectal procedures . The 40 patients who received postoperative metoclopramide were in Group 1 , and the 53 who did not were in Group 2 . The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days , and 3.5 and 5.0 days , respectively . These differences were not statistically significant ( P>0.05 ) . Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2 . These differences were also not statistically significant ( P>0.05 ) . Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake . We conclude that metoclopramide does not significantly alter the course of postoperative ileus Postoperative ileus ( POI ) is a transient loss of coordinated peristalsis precipitated by surgery and exacerbated by opioid pain medication . Ileus causes a variety of symptoms including bloating , pain , nausea , and vomiting , but particularly delays tolerance of oral diet and liquids . Thus POI is a primary determinant of hospital stay after surgery . ‘ Fast-track ’ recovery protocol s , opioid sparing analgesia , and laparoscopic surgery reduce but do not eliminate postoperative ileus . Alvimopan is a mu opioid receptor antagonist that blocks the effects of opioids on the intestine , while not interfering with their central ly mediated analgesic effect . Several large r and omized clinical trials have demonstrated that alvimopan accelerates the return of gastrointestinal function after surgery and subsequent hospital discharge by approximately 20 hours after elective open segmental colectomy . However , it has not been tested in patients undergoing laparoscopic surgery and is less effective in patients receiving nonsteroidal anti-inflammatory agents in a narcotic sparing postoperative pain control regimen . Safety concerns seen with chronic low dose administration of alvimopan for opioid bowel dysfunction have not been noted with its acute use for POI INTRODUCTION While enhanced recovery after surgery ( ERAS ) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay , its impact on recovery of bowel motility is poorly documented . The aims of this study were to assess the impact of ERAS on bowel motility recovery , and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature . MATERIAL AND METHODS This is a single-center prospect i ve observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months .  Global resumption of intestinal transit ( GROT ) was defined as passage of stool combined with alimentary tolerance of solid food . RESULTS One hundred and thirty-one patients were included . A median of 14 items ( range : 13 - 16 ) was complied out of 19 observable items in the protocol . Median time to passage of flatus ( MTPF ) was 2 days and the GROT was 3 days . The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased ( respectively P<0.001 , r2=0.11 and P=0.04 , r2=0.06 ) . The incidence of postoperative " ileus " varied from 1.5 % to 61.8 % depending on the interval chosen to define ileus ( cut-off from 1 to 7 days ) . Adherence to≥85 % of the items in the ERAS protocol protected patients from " prolonged ileus " , i.e. , lasting≥4 days ( OR=0.35 ; 95 % CI=0.15 to 0.83 ) . CONCLUSION The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT . There is a need for a consensual definition of postoperative ileus Aim : Postoperative ileus is an important factor of complications following gastrointestinal procedures . Its pathophysiology and the parameters , which may impact on its duration , remain unclear . The aim of this study was to measure the role of various clinical determinants on restoration of intestinal function after  elective colorectal surgery .  Methods : From July 2002 to September 2003 , all patients who underwent laparotomy for colectomy ( laparoscopic resections excluded ) with either an ileotransverse , colocolic , or high colorectal anastomosis  were entered in this prospect i ve study . The intervals in hours between the end of the surgical procedure and passing of flatus ( PG ) and passing of stool ( PS ) were recorded by an independent investigator . PG and PS were eventually correlated with the following parameters : type of colectomy , early removal of nasogastric tube ( NGT ) , mechanical bowel preparation ( MBP ) , type of underlying disease , systemic administration of opiates , and surgical training ( colorectal fellowship or other ) . Results : One hundred twenty-four patients were entered in this study . Four patients ( 3.2 % ) developed septic complications ( 3 anastomotic leaks and 1 intraabdominal abscess ) and were excluded from the analysis . Median age in this population was 68 ( range 30–95 ) years .  Mean duration of postoperative ileus was 70±28 h ( PG ) and 99±34 h ( PS ) . The type of colectomy , underlying disease , MBP , and early NGT removal failed , in univariate analysis , to correlate with the duration of postoperative ileus . By contrast , time intervals PG and PS were statistically shorter in the group of patients treated by a colorectal surgeon [ 56±23 vs 74±28 h ( PG ) ; 82±26 vs 103±35 h ( PS ) , p=0.004 ] , as well as in patients who received systemic opiates for less than 2 days [ 64±27 vs 75±28 h ( PG ) , p=0.04 ; 88±32 vs 108±33 h ( PS ) , p=001 ] . Conclusion : Restoration of normal intestinal function after elective open colectomy takes 3 ( PG ) to 4 ( PS ) days . In our series , specialized training in colorectal surgery has a positive impact on the duration of postoperative ileus . Surgical specialization should be considered an important parameter in future clinical trials aim ing to minimize postoperative ileus BACKGROUND Early enteral feeding has been shown to be beneficial in improving outcome in critically injured trauma patients . Delayed gastric emptying occurs frequently in trauma patients , increasing the time to achieve nutritional goals , and limiting the benefit of early enteral feedings . Intravenous erythromycin is an effective agent for improving gastric motility in diabetics and postgastrectomy patients . The purpose of this study is to determine the effectiveness of erythromycin for improving gastric motility in critically injured trauma patients . METHODS All critically injured patients who received gastric feedings within 72 hours of admission were c and i date s for the study . Those patients who failed to tolerate feedings at 48 hours ( gastric residual > 150 mL ) were eligible for enrollment . Patients were prospect ively assigned to two treatment groups by r and omization to receive either erythromycin ( ERY ) or placebo ( PLA ) . Treatment was continued in patients who tolerated gastric feedings until the feedings were no longer required . Patients with continued intolerance for 48 hours after r and omization were considered failures of therapy and given metoclopramide . RESULTS Sixty-eight patients were enrolled and were well matched for age , sex , and Injury Severity Score . Mortality , intensive care unit length of stay , hospital length of stay , number of ventilator days , and rate of nosocomial infections were similar in each group . There was a significant difference between the ERY group and the PLA group in the amount of feedings tolerated at 48 hours ( 58 % vs. 44 % , p = 0.001 ) . There was no difference in the amount of feedings tolerated ( as a percentage of target goal volume ) throughout the entire duration of the study ( ERY [ 65 % of target ] vs. PLA [ 59 % ] , p = 0.061 ) . Overall success of therapy at 48 hours was 56 % in the ERY group versus 39 % in the PLA group , but this also did not reach statistical significance ( p = 0.22 ) . CONCLUSION Intravenous erythromycin improves gastric motility and enhances early nutritional intake in critically injured patients OBJECTIVE : Etoricoxib is a selective cyclooxygenase inhibitor that in clinical studies has improved the signs and symptoms of osteoarthritis and rheumatoid arthritis and reduced the potential for GI injury . The incidence of endoscopically detected ulcers and of clinical ly important upper GI events ( perforations , ulcers , and bleeding episodes ) was compared in patients taking etoricoxib or nonselective nonsteroidal anti-inflammatory drugs ( NSAIDs ) .  METHODS : Upper GI endoscopy was performed at intervals over 12 wk in 680 patients taking etoricoxib 120 mg once daily , ibuprofen 800 mg three times daily , or placebo in a r and omized , parallel-group , double-blind study .  Survival analysis was used to analyze time-to-event data for the incidence of gastric or duodenal ulcers ( ≥3 mm and ≥5 mm ) , and the log rank test was used to compare the cumulative incidence between treatment groups . A combined analysis of upper GI events in all 10 Phase II/III clinical trials of etoricoxib ( 60 , 90 , or 120 mg ) versus nonselective NSAIDs ( naproxen , ibuprofen , or diclofenac ) for osteoarthritis , rheumatoid arthritis , and chronic low back pain was conducted . Investigators reported potential events for adjudication by an external , blinded committee , using prespecified criteria to confirm events . All events that occurred during active treatment periods ( maximum 792 days ) or within 14 days of stopping treatment were included in the analysis . Time to first event was evaluated using survival analysis ; the Kaplan – Meier method was used to determine the cumulative incidence , and relative risk was estimated with the Cox proportional hazards model . RESULTS : In the endoscopy study , the cumulative incidence of ulcers ≥3 mm at 12 wk in the ibuprofen group ( 17 % ) was significantly higher than in the etoricoxib group ( 8.1 % , p < 0.001 ) ; similar results were seen for ulcers ≥5 mm . In the placebo group , the rate of ulcers ≥3 mm was 1.86 % . Of 3142 patients treated with once-daily etoricoxib and 1828 patients treated with a nonselective NSAID ( ibuprofen , naproxen , or diclofenac ) , 82 patients with investigator-reported upper GI events ( 71 confirmed ) were eligible for the combined analysis . For etoricoxib versus NSAIDs  , the rate per 100 patient-yr for confirmed events was 1.16 versus 3.05 ( relative risk = 0.44 , 95 % CI = 0.27–0.72 , p < 0.001 ) , whereas that for investigator-reported events was 1.35 versus 3.42 ( relative risk = 0.47 , 95 % CI = 0.30–0.74 , p = 0.001 ) . Results were driven primarily by studies with naproxen as the comparator . CONCLUSIONS : The incidence of endoscopically detected ulcers was significantly lower with etoricoxib 120 mg than with ibuprofen 2400 mg . Treatment with etoricoxib reduced the incidence of investigator-reported and confirmed adverse upper GI events by approximately 50 % compared with treatment with nonselective NSAIDs Background Postoperative ileus is a common condition after abdominal surgery . Many prokinetic drugs have been evaluated including osmotic laxatives . The data on colon-stimulating laxatives are scarce . This prospect i ve , r and omized , double-blind trial investigates the effect of the colon-stimulating laxative bisacodyl on postoperative ileus in elective colorectal resections . Material s and methods Between November 2004 and February 2007 , 200 consecutive patients were r and omly assigned to receive either bisacodyl or placebo . Primary endpoint was time to gastrointestinal recovery ( mean time to first flatus passed , first defecation , and first solid food tolerated ; GI-3 ) . Secondary endpoints were incidence and duration of nasogastric tube reinsertion , incidence of vomiting , length of hospital stay , and visual analogue scores for pain , cramps , and nausea . Results One hundred sixty-nine patients were analyzed , and 31 patients discontinued the study . Groups were comparable in baseline demographics . Time to GI-3 was significantly shorter in the bisacodyl group ( 3.0 versus 3.7 days , P = 0.007 ) . Of the single parameters defining GI-3 , there was a 1-day difference in time to defecation in favor to the bisacodyl group ( 3.0 versus 4.0 days , P = 0.001 ) , whereas no significant difference in time to first flatus or tolerance of solid food was seen . No significant difference in the secondary endpoints was seen . Morbidity and mortality did not differ between groups . Conclusion Bisacodyl accelerated gastrointestinal recovery and might be considered as part of multimodal recovery programs after colorectal surgery Background : The objective is to eluci date the effects of oral bifid triple viable probiotics among patients with colorectal cancer . Methods : Sixty patients undergoing radical colorectal resection were r and omly assigned to 3-day ( days −5 to −3 ) preoperative probiotics ( group A , n = 30 ) or placebo ( group B , n = 30 ) treatment . The alteration of intestinal flora was evaluated by fecal cultures of Escherichia coli , Bifidobacterium longum and intestinal fungi ; the gut barrier function by serum endotoxins and D-lactic acids and the immune and stress responses by peripheral blood immunoglobins , interleukin-6 and C-reactive protein . Postoperative infections were documented physically , radiologically and microbiologically . Results : Inverted Bifidobacterium/Escherichia ratios were preoperatively and postoperatively present in group B ( both P < 0.05 ) . Bifidobacterium counts increased significantly , whereas Escherichia counts decreased significantly on postoperative days 3 to 5 ( P < 0.05 ) , along with reversing the Bifidobacterium/Escherichia ratio inversion until postoperative days 3 to 5 in group A. Group A also had lower levels of endotoxins , D-lactic acids , serum interleukin-6 and C-reactive protein but higher levels of serum IgG and sIgA ( all P < 0.05 ) than group B. The incidences of postoperative infectious complications were 3.3 % to 6.7 % and 3.3 % to 30 % in groups A and B ( overall , 10.0 % versus 33.3 % , P < 0.05 ) , respectively . Conclusion : The preoperative oral bifid triple viable probiotics minimize the postoperative occurrence of infectious complications , with possible mechanisms attributed to the maintenance of the intestinal flora and restriction of bacterial translocation from the intestine . It was representative of the enhancement of systemic/localized immunity and concurrent attenuation of systemic stress response STUDY OBJECTIVE To assess the efficacy of metoclopramide for treatment of postoperative ileus in patients who underwent exploratory laparatomy .  DESIGN Prospect i ve observational study SETTING Surgical intensive care unit ( SICU ) . PATIENTS Thirty-two patients who underwent exploratory laparatomy INTERVENTION Sixteen patients received metoclopramide  , and 16 did not . The primary outcome was time to first postoperative bowel movement . Secondary end points were length of stay ( LOS ) in the SICU and total hospital LOS . MEASUREMENTS AND MAIN RESULTS The mean number of days to first bowel movement was nearly identical for both the treatment group and control group ( 4.8 vs 4.7 days , respectively , p=0.93 ) . Length of stay in the SICU was 8.3 days for the treatment group and 8.6 days for the control group ( p=0.89 ) , and total LOS was 18.0 and 20.1 days , respectively ( p=0.63 ) . CONCLUSION The time to first bowel movement was not significantly different between the treatment and control groups . Also , metoclopramide did not decrease LOS .  Metoclopramide does not have a role in the treatment of postoperative ileus PURPOSE : Nausea and vomiting three to seven days after an elective operation on the colon and rectum remain a persistent clinical problem . Erythromycin , a safe , inexpensive drug that stimulates intestinal motilin receptors , has previously been shown to accelerate gastric emptying significantly after upper gastrointestinal surgery . We aim ed to evaluate the effect of postoperative intravenous erythromycin on postoperative ileus in patients undergoing elective surgery for primary colorectal cancer . METHODS : Between May 1998 and April 1999 , 150 patients undergoing primary resection of colon or rectal cancer were enrolled in this prospect i ve , r and omized , placebo-controlled trial . One hundred thirty-four patients completed the study . Patients were excluded if they had extensive metastatic disease , were taking medications known to interact with erythromycin , or if they required an ileostomy . Patients received either 200 mg of intravenous erythromycin or placebo every six hours . Clinical endpoints were recorded and continuous endpoints are presented as mean ± st and ard deviation . RESULTS : There were no significant complications related to erythromycin . The erythromycin ( n=65 ) and placebo ( n=69 ) groups were comparable regarding demographic and operative factors . The erythromycin group had a slightly shorter length of time to passage of flatus ( 4.1 ± 1.3vs . 4.4 ± 1.1 days;P=0.03 ) . There was no significant difference between erythromycin and placebo  in time to first solid food ( 5.6 ± 1.9vs . 5.4 ± 1.8 days ) , time to first bowel movement ( 5.2 ± 1.9vs . 5.4 ± 1.3 days ) , or time to discharge from hospital ( 7.5 ± 2.0vs . 7.6 ± 2.8 days ) . There was no difference in the rate of clinical ly significant nausea ( 26vs . 26 percent;P=0.99 ) , vomiting ( 17vs . 16 percent;P=0.88 ) , or nasogastric tube placement ( 9vs . 7 percent;P=0.68 ) . CONCLUSIONS : Erythromycin does not seem to alter clinical ly important outcomes related to postoperative ileus in patients undergoing resection for colorectal cancer Background Perioperative prophylactic antibiotic treatment significantly influences intestinal microflora , result ing in impaired bowel functioning in some patients , sometimes requiring further investigations . This may lead to a worse health-related quality of life ( HRQoL ) . Probiotics administrated in the early post-operative period may help avoiding such nuisances in older people . Methods We prospect ively enrolled patients undergoing laparoscopic colorectal surgery aged over 70 years between 2005 and 2012 . The study was approved by IRB . All patients received perioperative antibiotic treatment . Patients were r and omized to one of two treatment arms : Group A patients received probiotics after surgery ( VSL#3 , VSL Pharmaceuticals , Inc. USA - 900 × 109 daily , while Group B patients received a Placebo ( cornstarch ) . Patients were further divided in sub-groups whether ileo-caecal valve was spared or not . Patients were followed-up every 7 days for 4 weeks . Patients daily annotated bowel frequency , stool shape and consistency - according to Bristol 's scale . HRQoL was assessed every week by means of SF-36 question naire . Results Group A included 10 while Group B included 8 patients . One patient in each group experienced a postoperative complication . Group A patients had fewer bowel movements than controls , during every week . Stool consistency was higher in patients undergoing resections including ileo-caecal valve receiving VSL#3  . HRQoL gradually increased in both groups ; Group A patients had higher " social functioning " item scores at week 1 and 4 than controls . Conclusions Elderly patients undergoing resection of ileo-caecal valve may benefit from an early probiotics administration pathway after perioperative antibiotic treatment
Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .