Prevention of Postoperative Ileus After Colon Surgery

Primary Prevention Strategies

The American Society for Enhanced Recovery recommends mid-thoracic epidural analgesia as it is highly effective at preventing postoperative ileus 1, 2
The American College of Surgeons suggests a laparoscopic surgical approach when possible, as it leads to faster return of bowel function compared to open surgery 1, 2
The European Society for Clinical Nutrition and Metabolism advises avoiding fluid overload during and after surgery, as it impairs gastrointestinal function 1, 2
The American Gastroenterological Association recommends avoiding nasogastric decompression, as it may prolong the duration of postoperative ileus 1, 2
The Society of Surgical Oncology suggests implementing chewing gum starting as soon as the patient is awake, as it has a positive effect on postoperative duration of ileus 1, 2, 3

The American College of Gastroenterology recommends oral magnesium oxide to promote postoperative bowel function once oral intake is resumed 1, 2
The European Society for Clinical Nutrition and Metabolism suggests bisacodyl (10 mg PO twice daily) from the day before surgery to the third postoperative day to improve postoperative intestinal function 1, 2
The American Pain Society recommends alvimopan (μ-opioid receptor antagonist) when opioid-based analgesia is necessary, as it accelerates gastrointestinal recovery 1, 2

The National Comprehensive Cancer Network recommends metoclopramide at a dose of 10-20 mg PO QID as a prokinetic agent for persistent ileus 4, 3
The American Geriatrics Society advises monitoring for extrapyramidal side effects, particularly in elderly patients, when using metoclopramide 3

The American Society for Enhanced Recovery warns against fluid overload, as it worsens intestinal edema and prolongs ileus 1, 2, 5
The American College of Clinical Pharmacy recommends monitoring for medication side effects, particularly extrapyramidal symptoms with metoclopramide 3