Postoperative ileus after digestive surgery: Network meta‐analysis of pharmacological intervention

Abstract

AimsSeveral medicinal treatments for avoiding postoperative ileus (POI) after abdominal surgery have been evaluated in randomized controlled trials (RCTs). This network meta‐analysis aimed to explore the relative effectiveness of these different treatments on ileus outcome measures.MethodsA systematic literature review was performed to identify RCTs comparing treatments for POI following abdominal surgery. A Bayesian network meta‐analysis was performed. Direct and indirect comparisons of all regimens were simultaneously compared using random‐effects network meta‐analysis.ResultsA total of 38 RCTs were included in this network meta‐analysis reporting on 6371 patients. Our network meta‐analysis shows that prokinetics significantly reduce the duration of first gas (mean difference [MD] = 16 h; credible interval −30, −3.1; surface under the cumulative ranking curve [SUCRA] 0.418), duration of first bowel movements (MD = 25 h; credible interval −39, −11; SUCRA 0.25) and duration of postoperative hospitalization (MD −1.9 h; credible interval −3.8, −0.040; SUCRA 0.34). Opioid antagonists are the only treatment that significantly improve the duration of food recovery (MD −19 h; credible interval −26, −14; SUCRA 0.163).ConclusionBased on our meta‐analysis, the 2 most consistent pharmacological treatments able to effectively reduce POI after abdominal surgery are prokinetics and opioid antagonists. The absence of clear superiority of 1 treatment over another highlights the limits of the pharmacological principles available.