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Abstract：
BACKGROUND: Postoperative ileus (POI) is one of the most common postoperative complications after colorectal surgery and prolongs hospital stays. Minimally invasive surgery (MIS) has reduced POI, but it remains common. This review explores the current methods for preventing and managing POI after MIS.
CONCLUSIONS: Preoperative interventions, including optimising nutrition, preoperative medicationn, and mechanical bowel preparation with oral antibiotics, may have a role in preventing POI. Transversus abdominis plane blocks and lidocaine could replace epidural analgesia in MIS. Fluid overload should be avoided; in some cases, goal-directed fluid therapy may aid in achieving this. Pharmacological agents, such as prucalopride and dexmedetomidine, could target mechanisms underlying POI. New strategies to stimulate vagal nerve activity may promote postoperative gastrointestinal motility. Preoperative bowel stimulation could potentially reduce POI following loop ileostomy closure. However, the evidence base for several interventions remains weak and requires further corroboration with robust studies.
CONCLUSIONS: Despite the increasing use of MIS, POI remains a major issue following colorectal surgery. Further strategies to prevent POI are rapidly emerging. Studies using standardised definitions and perioperative care will help validate these interventions and remove barriers to accurate meta-analysis. Future studies should focus on establishing the impact of these interventions on POI after MIS specifically.
CONCLUSIONS: Preoperative interventions, including optimising nutrition, preoperative medicationn, and mechanical bowel preparation with oral antibiotics, may have a role in preventing POI. Transversus abdominis plane blocks and lidocaine could replace epidural analgesia in MIS. Fluid overload should be avoided; in some cases, goal-directed fluid therapy may aid in achieving this. Pharmacological agents, such as prucalopride and dexmedetomidine, could target mechanisms underlying POI. New strategies to stimulate vagal nerve activity may promote postoperative gastrointestinal motility. Preoperative bowel stimulation could potentially reduce POI following loop ileostomy closure. However, the evidence base for several interventions remains weak and requires further corroboration with robust studies.
CONCLUSIONS: Despite the increasing use of MIS, POI remains a major issue following colorectal surgery. Further strategies to prevent POI are rapidly emerging. Studies using standardised definitions and perioperative care will help validate these interventions and remove barriers to accurate meta-analysis. Future studies should focus on establishing the impact of these interventions on POI after MIS specifically.
摘要：
背景：术后肠梗阻（POI）是结直肠手术后最常见的术后并发症之一，可延长住院时间。微创手术（MIS）降低了POI，但它仍然很常见。本文探讨了当前MIS后预防和管理POI的方法。
结论：术前干预，包括优化营养，术前用药,和口服抗生素的机械肠道准备，可能在预防POI中发挥作用。腹横肌平面阻滞和利多卡因可以替代MIS中的硬膜外镇痛。应避免流体过载；在某些情况下，目标导向的液体治疗可能有助于实现这一目标.药理学试剂，如普洛必利和右美托咪定，可以瞄准潜在的POI机制。刺激迷走神经活动的新策略可能会促进术后胃肠蠕动。术前肠道刺激可能会减少回肠造口术闭合后的POI。然而,几项干预措施的证据基础仍然薄弱,需要通过强有力的研究进一步证实.
结论：尽管管理信息系统的使用越来越多，POI仍然是结直肠手术后的主要问题。预防POI的进一步策略正在迅速出现。使用标准化定义和围手术期护理的研究将有助于验证这些干预措施并消除准确荟萃分析的障碍。未来的研究应集中于确定这些干预措施对MIS后POI的影响。
结论：术前干预，包括优化营养，术前用药,和口服抗生素的机械肠道准备，可能在预防POI中发挥作用。腹横肌平面阻滞和利多卡因可以替代MIS中的硬膜外镇痛。应避免流体过载；在某些情况下，目标导向的液体治疗可能有助于实现这一目标.药理学试剂，如普洛必利和右美托咪定，可以瞄准潜在的POI机制。刺激迷走神经活动的新策略可能会促进术后胃肠蠕动。术前肠道刺激可能会减少回肠造口术闭合后的POI。然而,几项干预措施的证据基础仍然薄弱,需要通过强有力的研究进一步证实.
结论：尽管管理信息系统的使用越来越多，POI仍然是结直肠手术后的主要问题。预防POI的进一步策略正在迅速出现。使用标准化定义和围手术期护理的研究将有助于验证这些干预措施并消除准确荟萃分析的障碍。未来的研究应集中于确定这些干预措施对MIS后POI的影响。
