Efficacy and safety of therapeutic means for postoperative ileus: an umbrella review of meta-analyses

Abstract

Background & aims: Postoperative ileus is treated using a large number of methods with variable efficacy. This study further clarifies the advantages and disadvantages of existing treatments through umbrella evaluation. Method: This study conducted a systematic search of databases to select and include meta-analyses discussing the treatment of postoperative ileus. We recalculated the estimated values, 95% confidence intervals, heterogeneity estimates, small study effects, excessive significance tests, and publication biases for each included study using both random and fixed effect models. Results: A total of 24 meta-analyses, including 27 treatment protocols, were reviewed in this study. Among them, chewing gum, coffee, ERAS(Enhanced Recovery After Surgery) protocols, acupuncture, opioid receptor antagonists, Da-Cheng-Qi-Tang, early enteral nutrition, and Zusanli point injection therapy have been shown to significantly improve postoperative ileus (Class II). Opioid receptor antagonists, early enteral nutrition, ERAS, and chewing gum have also been found to significantly reduce the postoperative hospital stay (Class II). Conclusion: Eight treatment options can effectively reduce postoperative ileus, while the effectiveness and safety of other treatment options for postoperative ileus require further confirmation through high-quality research.