Work

Implementation of a standardized postoperative ileus management pathway: a prospective single-center feasibility study

Year: 2026

Type: article

Abstract: Background Postoperative ileus (POI) remains one of the most frequent complications after gastrointestinal surgery with only limited options for prevention and treatment. Management of POI shows wide variation due to limited evidence. The aim was to establish a standardized treatment algorithm for POI and to study its feasibility and safety. Methods This was a prospective, single-center study conducted at a tertiary care hospital, enrolling patients from June 2023 to March 2024 who developed postoperative ileus (POI) and required nasogastric tube (NGT) insertion after abdominal surgery. An Ileus Management Algorithm for Postoperative Ileus (I-MAP) was developed at our institution. The primary outcome was pathway compliance, secondary outcomes included postoperative complications and length of hospital stay. Results In 9 months, 60 patients with POI were screened for eligibility and 47 were included in the trial. 40 patients were treated according to the algorithm (compliance 85%) and 38/40 (95%) were successfully treated conservatively. Median NGT time was 2 (IQR 2–4) days, and 3 patients required NGT reinsertion (10%) after prior removal. Median hospital stay was 13 days (IQR 8–18) days and 9 days (IQR 5–14) after surgery and insertion of NGT, respectively. One bronchoaspiration was documented in this prospective cohort. Conclusions The suggested POI algorithm proved to be feasible and safe. Its superiority compared with best physician’s choice needs to be confirmed through a multicenter randomized trial.

Source: International Journal of Colorectal Disease

DOI: 10.1007/s00384-026-05229-0