|October 2003 · Vol. 15, No. 10
3 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.
Dr. 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,
Rather than contributing to ileus, early postoperative feeding now appears to help diminish its occurrence.
There is no justification for routine postoperative placement of nasogastric tubes in asymptomatic patients.
Thoracic epidurals block the reflex that causes postoperative ileus and can be used to prevent its occurrence.
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ileus following cesarean delivery and other abdominal surgeries; now it appears the thinking behind that strategy is outdated.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.