Post-Operative Ileus After Digestive Surgery: Network Meta-Analysis of
Pharmacological Intervention.
Abstract
Background: Several medicinal treatments for avoiding post-operative
ileus (POI) after abdominal surgery have been evaluated in randomised
controlled trials. This network meta-analysis aimed to explore the
relative effectiveness of these different treatments on ileus outcome
measures. Methods: A systematic literature review was performed to
identify randomised controlled trials (RCTs) comparing treatments for
post-operative ileus 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. Results: A total of 38 randomised controlled trials 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) (hours) – 16; credible
interval - 30, - 3.1; surface under the cumulative ranking curve (SUCRA)
0.418), duration of first bowel movements (Mean difference (MD) (hours)
-25; credible interval - 39, - 11; SUCRA 0.25) and duration of
post-operative hospitalisation (Mean difference (MD) (hours) – 1.9;
credible interval – 3.8, - 0.040; SUCRA 0.34). Opioid antagonists are
the only treatment that significantly improve the duration of food
recovery (Mean difference (MD) (hours) - 19; credible interval - 26, -
14; SUCRA 0.163). Conclusion: Based on our meta-analysis, the two most
consistent pharmacological treatments able to effectively reduce POI
after abdominal surgery are prokinetics and opioid antagonists. The
absence of clear superiority of one treatment over another highlights
the limits of the pharmacological principles available.