Implications of postoperative ileus: From experimental to clinical studies

Postoperative ileus is a clinical condition of prolonged gastrointestinal recovery following colorectal surgery in general, due to non-mechanical factors that disrupt the normal coordinated propulsive motor activity of the gastrointestinal tract. Through manipulation of the intestine during surgery, an inflammatory process in the intestinal wall develops, which again can be reduced by stimulation of the vagus nerve. The vagus nerve can be stimulated in various ways, and in this thesis perioperative lipid-enriched nutrition is used. We used this concept in a double-blind randomized controlled trial with 280 patients undergoing colorectal surgery. In this study perioperative lipid-enriched nutrition did not reduce postoperative complications. Furthermore in this thesis, we describe various strategies to reduce postoperative ileus in the clinical setting, to what extent postoperative ileus has an impact on patients and the development of other complications, and which other variables, such as bacteria in the gut, potentially contribute to postoperative ileus. Our findings in this thesis describing clinical mechanisms in the development of complications after colorectal surgery, and their impact on patient and society are a direct plea for future research aimed at therapies that reduce the inflammatory response and finding biomarkers that will show whether postoperative ileus and anastomotic leakage can be reduced.