October 2003 · Vol. 15, No. 103 steps to reduce postoperative ileus
A new assessment of the evidence favors a counter-intuitive approach. Here, a practitioner reviews the role of postoperative feeding, nasogastric tube placement, and type of anesthetic.
STEPHEN
ROSENMAN,
MDDr. Rosenman is chief of gynecology and resident program director, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, Conn, and assistant clinical professor of obstetrics and gynecology, Yale Medical School,
New Haven, Conn.
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KEY POINTS
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Rather than contributing to ileus, early postoperative feeding now appears to help diminish its occurrence.
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There is no justification for routine postoperative placement of nasogastric tubes in asymptomatic patients.
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Thoracic epidurals block the reflex that causes postoperative ileus and can be used to prevent its occurrence.
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For many years, a single standard of care governed the prevention of postoperative ileus following cesarean delivery and other abdominal surgeries; now it appears the thinking behind that strategy is outdated.
Traditionally, the routine approach to avoiding this complication consisted of placing a nasogastric (NG) tube to decompress the bowel and delaying feeding until bowel function resumed.
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