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Reduction of postoperative ileus in gastrointestinal surgery: systematic review and meta-analysis.

  • 2025-03
  • Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 29(3)
    • Doris Sarmiento-Altamirano
    • Daniel Arce-Jara
    • Pablo Balarezo-Guerrero
    • Rafael Valdivieso-Espinoza

Study Design

Type
Meta-Analysis
Sample size
n = 4,647
Population
patients undergoing gastrointestinal surgeries
Methods
Systematic search following PRISMA guidelines on Google Scholar, PubMed, ScienceDirect, and Web of Science; studies on coffee, chewing gum, electroacupuncture, daikenchuto, and prokinetic agents were analyzed; subgroup analyses of mean differences for time to first flatus and first stool
Funding
Unclear

Background

Postoperative ileus is a surgical complication that affects intestinal motility. There are measures to reduce this problem, but not all have conclusive evidence. This study aimed to determine which measures, such as coffee, chewing gum (CG), electroacupuncture (EA), daikenchuto (DKT), and prokinetic agents, are most effective in reducing postoperative ileus in patients undergoing gastrointestinal surgeries.

Methods

A systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Google Scholar, PubMed, ScienceDirect, and Web of Science. The following measures were studied to define postoperative ileus: time to passage of the first flatus and time to passage of the first stool. The mean differences were determined by subgroup analyses.

Results

Of 176 studies, 37 were selected for the systematic review, which involved 4647 patients. The reduction in time to passage of the first flatus was -18.33 h (95% CI, -26.46 to -10.20; P <.01) for EA, -5.83 h (95% CI, -9.40 to -2.26; P <.01) for DKT, -14.87 h (95% CI, -26.84 to -2.90; P =.01) for CG, and -1.90 h (95% CI, -8.28 to 4.48; P =.56) for coffee. The reduction in time to passage of the first stool was -32.27 h (95% CI, -39.28 to -25.26; P <.01) for prokinetic agents, -23.05 h (95% CI, -29.31 to -16.78; P <.01) for CG, -12.89 h (95% CI, -17.78 to -8.01; P <.01) for coffee, -19.76 h (95% CI, -32.79 to -6.72; P <.01) for EA, and -0.70 h (95% CI, -25.51 to 26.92; P =.96) for DKT.

Conclusion

The use of CG, EA, and prokinetic agents decreased the time to passage of the first flatus and time to passage of the first stool and indirectly reduced postoperative ileus.

Research Insights

  • Coffee→Reduced Time to First Flatus

    The reduction in time to passage of the first flatus was -1.90 h (95% CI, -8.28 to 4.48; P =.56) for coffee.

    Effect
    Neutral
    Effect size
    Small
    Dose
    not specified
  • Coffee→Reduced Time to First Stool

    The reduction in time to passage of the first stool was ... -12.89 h (95% CI, -17.78 to -8.01; P <.01) for coffee

    Effect
    Beneficial
    Effect size
    Small
    Dose
    not specified
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