Pathophysiologic, translational and clinical aspects of postoperative ileus – A review

1. Postoperative ileus (POI) is an abnormal pattern of gastrointestinal motility characterized by nausea, vomiting, abdominal distension and/or delayed passage of flatus or stool which may occur following surgery. POI slows patient recovery, increases the risk of developing postoperative complications, and confers a significant financial load on healthcare institutions. 2. The aim of this review is to provide a succinct overview of the clinical features and pathophysiologic mechanisms of POI, with final comment on selected directions for future research. 3. Terminology used when describing POI is inconsistent, with little differentiation made between the obligatory period of gut dysfunction seen after surgery (‘normal POI’) and the more clinically and pathologically significant entity of a ‘prolonged POI’. This has impaired ability to determine incidence and risk factors of ileus, and has compromised the external validity of clinical trials investigating it. Both normal and prolonged POI represent a fundamentally similar pathophysiologic phenomenon. 4. The aetiology of POI is postulated to be multifactorial with principal mediators being inflammatory cell activation, autonomic dysfunction (both primarily and as part of the surgical stress response), agonism at gut opioid-receptors, modulation of gastrointestinal hormone activity, and electrolyte derangements. A final common pathway for these effectors is impaired contractility and motility, and gut wall oedema. 5. There are many potential directions for future research. In particular, there remains scope to accurately characterize the gastrointestinal dysfunction that underscores an ileus; development of an accurate risk stratification tool will facilitate early implementation of preventive measures; and clinical appraisal of novel therapeutic strategies that target individual pathways in the pathogenesis of ileus warrant further investigation.