Postoperative Ileus Management:
Examining the Role of Emerging Therapies 

Symposium Overview: 

 Postoperative ileus (POI) is the most common cause of delayed hospital discharge after abdominal surgery. POI is a major cause of increased usage of hospital resources, because discharge after surgery is typically delayed until the patient can tolerate a regular diet and acceptable bowel function is restored. In addition to the impact on the healthcare system, POI has a significant impact on patients. Signs and symptoms of POI include abdominal pain and distention, nausea and vomiting, and delayed passage of flatus or stool; POI is associated with significant patient discomfort. Furthermore, POI contributes to many comorbid postsurgical complications which include delayed surgical wound healing and ambulation, atelectasis, pneumonia, and deep vein thrombosis.

After surgery, inhibited motility of the gastrointestinal tract is related to disorganized electrical activity and lack of coordinated propulsion. The pathophysiology of POI is multi-factorial, involving neurogenic, inflammatory and pharmacologic mechanisms. A number of perioperative strategies have been instituted or modified attempting to prevent the development or reduce the duration of POI. Some of these have shown benefits, while others incorporated in the past have been shown to be counterproductive, and their use is now discouraged based on more recent information. When strategies demonstrating benefit are used in combination as part of a fast-track multimodal treatment plan, there is a significant decrease in time to return of normal bowel function and a shortened hospital stay.

Activation of mu-opioid receptors in the gastrointestinal tract is linked to inhibition of
gut motility; therefore, inhibition of this activation has become an optimal target for
opioid-induced bowel dysfunction. Novel mu-opioid receptor antagonists have been
developed, and results of studies reveal an acceleration of gastrointestinal recovery
with reductions in postoperative morbidity rates, prolonged hospital stay, and rates of
hospital readmission.

In this program, experts in POI will discuss the burden of POI and its pathogenesis,
and explain through lecture and interactive case presentation best practices in
management. In addition, a panel discussion will describe the important role of
pharmacists in the postoperative management of patients, including pain and POI
treatment.

Educational Objectives: