Perioperative Interventions for Prevention of Prolonged Postoperative Ileus and Gastrointestinal Recovery After Colorectal Surgery: A Systematic Review of Randomized Controlled Trials
9 affiliations
- 1Department of Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 2Advanced Research and Development Center for Experimental Medicine “Prof. Ostin C. Mungiu” (CEMEX), Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 3Medical Oncology-Radiotherapy Department, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 4Centre for Translational Medicine, Semmelweis University, 20 Baross Street, 1085 Budapest, Hungary
- 5Department of Legal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 6Faculty of Chemical Engineering and Environmental Protection “Cristofor Simionescu”, “Gheorghe Asachi” Technical University, 71A Mangeron Blvd., 700050 Iasi, Romania
- 7Department of Gastroenterology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 8Department Gastroenterology, St. Spiridon Hospital, 700111 Iasi, Romania
- 9Department of Surgery I, St. Spiridon Hospital, 700111 Iasi, Romania
Abstract
Background: Prolonged postoperative ileus (PPOI) remains a common complication after colorectal surgery, leading to delayed gastrointestinal recovery, prolonged hospitalization, and increased healthcare costs. Despite minimally invasive surgery and enhanced recovery protocols, postoperative gastrointestinal dysfunction remains frequent. Interpretation of current evidence is limited by substantial heterogeneity in PPOI definitions and outcome reporting. Methods: This systematic review was conducted according to PRISMA 2020 and Cochrane Handbook recommendations, following a protocol prospectively registered for PROSPERO (CRD420261307668). PubMed/MEDLINE, Embase, and CENTRAL were searched for randomized controlled trials published since January 2000 involving adult colorectal surgery patients. Studies evaluating all perioperative factors associated with PPOI were included. Screening, data extraction, and risk-of-bias assessment were independently performed by multiple reviewers. Findings were synthesized narratively according to perioperative phase and intervention type. Results: Of the 36 included RCTs, 7 (19.4%) reported an operational definition of POI/PPOI, of which 5 (13.9% of all included trials) applied a predefined time-based definition corresponding specifically to PPOI. The remaining studies reported POI/PPOI without sufficiently detailed diagnostic criteria or primarily assessed surrogate measures of gastrointestinal recovery. Across the included trials, effects on postoperative gastrointestinal recovery were heterogeneous, although selected analgesia strategies, early oral feeding, gum chewing, and selected pharmacological interventions showed potentially favorable effects on gastrointestinal recovery outcomes. Non-opioid and multimodal analgesic strategies were associated with earlier bowel recovery, with time to first flatus within 1.5–2 days and first bowel movement within 2–3 days. Although leukocyte count and CRP remained elevated postoperatively in the limited number of trials reporting these markers, no significant between-group differences were observed; therefore, these data do not establish an independent association between postoperative inflammation and PPOI. Conclusions: Because clinically defined PPOI was assessed in only a small proportion of included trials, the available evidence relates predominantly to postoperative gastrointestinal recovery rather than to prevention of clinically defined PPOI. PPOI remains a multifactorial complication arising within the complex interplay of surgical, pharmacological, inflammatory, and perioperative factors; however, the independent effects of opioid exposure, postoperative inflammation, and background recovery protocols cannot be established from the included trials unless these factors are directly randomized. Potential signals of benefit were observed with selected analgesic strategies, early feeding, gum chewing, and some pharmacological interventions; however, heterogeneity in PPOI definitions, interventions, and outcome reporting precludes definitive conclusions regarding their efficacy for PPOI prevention. Persistent heterogeneity in PPOI definitions limits direct comparison between studies. The randomized intervention–control comparisons identified potential signals of benefit for selected strategies, although their efficacy for preventing clinically defined PPOI remains uncertain.
Related
- Perioperative non-invasive brain stimulation for the prevention of postoperative delirium: a systematic review and meta-analysis of randomised controlled trials
- Perioperative transcutaneous auricular vagus nerve stimulation for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: protocol for a randomized, double-blind, sham-controlled trial
- The Effect of Perioperative Video Interventions on Postoperative Pain Control: A Systematic Review.
- Pregnancy Complicated by Citrin Deficiency and Gestational Diabetes Mellitus: Perioperative Metabolic Management and Postoperative Analgesic Challenges Following Caesarean Delivery
- Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study
BibTeX
@article{hleșcu2026perioperative,
title = {{Perioperative Interventions for Prevention of Prolonged Postoperative Ileus and Gastrointestinal Recovery After Colorectal Surgery: A Systematic Review of Randomized Controlled Trials}},
author = {Cristian-Ștefan Hleșcu and Ioana Creangă-Murariu and Andreea Laura Antohi and Andreea-Alexandra Hleșcu and Ana Simona Barna and Cristina Maria Muzică and Roxana Grigorovici and Alina Călin Frij and Bogdan-Ionel Tamba and Alexandru Grigorovici},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218532},
url = {https://www.mdpi.com/2077-0383/15/21/8532},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative Interventions for Prevention of Prolonged Postoperative Ileus and Gastrointestinal Recovery After Colorectal Surgery: A Systematic Review of Randomized Controlled Trials
AU - Cristian-Ștefan Hleșcu
AU - Ioana Creangă-Murariu
AU - Andreea Laura Antohi
AU - Andreea-Alexandra Hleșcu
AU - Ana Simona Barna
AU - Cristina Maria Muzică
AU - Roxana Grigorovici
AU - Alina Călin Frij
AU - Bogdan-Ionel Tamba
AU - Alexandru Grigorovici
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218532
UR - https://www.mdpi.com/2077-0383/15/21/8532
AB - Background: Prolonged postoperative ileus (PPOI) remains a common complication after colorectal surgery, leading to delayed gastrointestinal recovery, prolonged hospitalization, and increased healthcare costs. Despite minimally invasive surgery and enhanced recovery protocols, postoperative gastrointestinal dysfunction remains frequent. Interpretation of current evidence is limited by substantial heterogeneity in PPOI definitions and outcome reporting. Methods: This systematic review was conducted according to PRISMA 2020 and Cochrane Handbook recommendations, following a protocol prospectively registered for PROSPERO (CRD420261307668). PubMed/MEDLINE, Embase, and CENTRAL were searched for randomized controlled trials published since January 2000 involving adult colorectal surgery patients. Studies evaluating all perioperative factors associated with PPOI were included. Screening, data extraction, and risk-of-bias assessment were independently performed by multiple reviewers. Findings were synthesized narratively according to perioperative phase and intervention type. Results: Of the 36 included RCTs, 7 (19.4%) reported an operational definition of POI/PPOI, of which 5 (13.9% of all included trials) applied a predefined time-based definition corresponding specifically to PPOI. The remaining studies reported POI/PPOI without sufficiently detailed diagnostic criteria or primarily assessed surrogate measures of gastrointestinal recovery. Across the included trials, effects on postoperative gastrointestinal recovery were heterogeneous, although selected analgesia strategies, early oral feeding, gum chewing, and selected pharmacological interventions showed potentially favorable effects on gastrointestinal recovery outcomes. Non-opioid and multimodal analgesic strategies were associated with earlier bowel recovery, with time to first flatus within 1.5–2 days and first bowel movement within 2–3 days. Although leukocyte count and CRP remained elevated postoperatively in the limited number of trials reporting these markers, no significant between-group differences were observed; therefore, these data do not establish an independent association between postoperative inflammation and PPOI. Conclusions: Because clinically defined PPOI was assessed in only a small proportion of included trials, the available evidence relates predominantly to postoperative gastrointestinal recovery rather than to prevention of clinically defined PPOI. PPOI remains a multifactorial complication arising within the complex interplay of surgical, pharmacological, inflammatory, and perioperative factors; however, the independent effects of opioid exposure, postoperative inflammation, and background recovery protocols cannot be established from the included trials unless these factors are directly randomized. Potential signals of benefit were observed with selected analgesic strategies, early feeding, gum chewing, and some pharmacological interventions; however, heterogeneity in PPOI definitions, interventions, and outcome reporting precludes definitive conclusions regarding their efficacy for PPOI prevention. Persistent heterogeneity in PPOI definitions limits direct comparison between studies. The randomized intervention–control comparisons identified potential signals of benefit for selected strategies, although their efficacy for preventing clinically defined PPOI remains uncertain.
SN - 2077-0383
ER -