Facilitating early recovery of bowel motility after colorectal surgery: a systematic review
Version of Record online: 20 JUN 2013
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing
Volume 23, Issue 1-2, pages 24–44, January 2014
How to Cite
Wallström, Å. and Frisman, G. H. (2014), Facilitating early recovery of bowel motility after colorectal surgery: a systematic review. Journal of Clinical Nursing, 23: 24–44. doi: 10.1111/jocn.12258
- Issue online: 9 DEC 2013
- Version of Record online: 20 JUN 2013
- Manuscript Accepted: 4 JAN 2013
- colorectal surgery;
- enhanced recovery;
- gastrointestinal motility;
- multimodal treatment;
- postoperative care
Aims and objectives
To determine how restored gastrointestinal motility can be accelerated after colorectal surgery.
Regaining normal bowel functions after surgery is described as unexpectedly problematic. Postoperative ileus is expected after all surgery where the peritoneum is entered, and the length of surgery has little or no impact in terms of the duration of Postoperative ileus. There is some speculation about the best way to facilitate bowel motility after colorectal surgery.
A systematic review.
The computerised databases Medline, Scopus and CINAHL were searched to locate randomised, controlled trials by using the following keywords: colorectal surgery, postoperative ileus, recovery of function and gastrointestinal motility. The systematic search was limited to studies published between January 2002–January 2012. Reference lists were also searched manually.
A total of 34 randomised, controlled trials were included in the review. Recovery of gastrointestinal motility was accelerated when one of the following forms of treatment was administered: probiotics, early feeding in combination with multimodal regimens, pentoxifylline, flurbiprofen, valdecoxib, ketorolac, clonidine, ropivacaine, lidocaine or spinal analgesia. Gum chewing, preoperative carbohydrate loading, bisacodyl and Doppler-guided fluid management have an uncertain effect on bowel motility. The use of nonpharmacological interventions, intrathecal morphine, restricted fluid therapy and choline citrate yielded no significant acceleration in bowel motility.
A multimodal treatment, where the use of morphine is restricted, seems to be the best way to accelerate the recovery of gastrointestinal bowel motility. However, more studies are required to optimise the multimodal protocol.
Relevance to clinical practice
The early return of bowel functions leads to quicker overall postoperative recovery, which may ease patient discomfort and decrease hospitalisation costs.