Non-Pharmacological Treatments
There are several risk factors for postoperative ileus, however many of
those identified in studies cannot be modified. Chapuis et al .
conducted an observational study involving 2,400 patients undergoing
colorectal cancer surgery. The independent predictors of POI were male
gender, peripheral vascular history, history of respiratory pathology,
emergency surgery, intraoperative transfusion, stoma placement and
surgical procedure of over 3 hours’ duration (Chapuis et al., 2013).
Numerous publications have shown the effectiveness of early
rehabilitation measures on the post-operative course of abdominal
surgery and on intestinal motility in particular (Vlug et al., 2011).
The non-pharmacological measures used in these rehabilitation schemes,
widely described in the literature, are not discussed in this paper. The
broad outlines of these strategies can be described as a
”simplification” of patient management. Firstly, there is no routine
placement of a nasogastric tube because prophylactic emptying of the
stomach has not highlighted any improvement in transit recovery (Vlug et
al., 2012). This equipment allows the patient to be mobilised early,
which is also a factor in the recovery of gut motility (Vlug et al.,
2011). Another important aspect is the monitoring of the balanced fluid
state in order to prevent visceral oedema that increases the risk of POI
and anastomotic leakage (Shah et al., 2011). Finally, as shown in the
LAFA trial involving 400 post-colectomy patients, the laparoscopic
approach allows a median return to tolerate food one day earlier and a
faster discharge from hospital with a median reduction of 1 day in the
length of stay (Vlug et al., 2011).