INTRODUCTION
Post-operative ileus is a common condition occurring after abdominal surgery and reflects a slowing or complete cessation of bowel motility1. This complication is common and variable among series, affecting between 10 and 25% of patients after abdominal surgery2. The costs associated with post-operative ileus are considerable. In the United States, the total annual cost of care for all hospitalisations related to paralytic ileus increased from $7.1 billion in 2001 to $12.3 billion in 20113. Post-operative ileus (POI) induces its own morbidity and prolongs hospital length of stay. Pathophysiologic studies have identified at least two phases in post-operative ileus, an early phase involving neural pathways known as the ”neurogenic phase” and a later phase which is characterised by inflammatory features4. Since the end of the 1970s, numerous clinical trials have been set up to evaluate the efficacy of different pharmacological treatments targeting inflammation, gastric movement or microbiota. Based on the variety of treatments and definitions of ileus in current clinical practice, it seemed necessary to compare the various pharmacological approaches used in the treatment of ileus5. A network approach using hierarchical Bayesian models allows indirect comparisons of pharmacological therapies for ileus after abdominal surgery and produces previously unexplored relative effectiveness. We conducted a systematic review identifying all randomised controlled trials evaluating pharmacological interventions to treat post-operative ileus after abdominal surgery5. After identifying the studies, we performed a networked meta-analysis of all available high-quality trials to provide new evidence in favour of pharmacological treatments to reduce ileus.