Post-operative Ileus after Minimally Invasive Colorectal Surgery: a summary of current strategies for prevention and management.

Background Postoperative ileus (POI) is one of the most common postoperative complications after colorectal surgery and prolongs hospital stays. Minimally invasive surgery (MIS) has reduced POI, but it remains common. This review explores current methods for preventing and managing POI after MIS. Summary Preoperative interventions, including exercise programmes and mechanical bowel preparation (MBP) with oral antibiotics, have a role in preventing POI. Transversus abdominis plane blocks (TAPBs) and lidocaine could replace epidural analgesia in MIS. Fluid overload should be avoided, in some cases goal-directed fluid therapy may aid in achieving this. Pharmacological agents, such as prucalopride and dexmedetomidine could target mechanisms underlying POI. New strategies to stimulate vagal nerve activity may promote postoperative gastrointestinal motility. Preoperative bowel stimulation could potentially reduce POI following loop ileostomy closure. However, the evidence-base for several interventions remains weak and requires further corroboration with robust studies. Key Messages Despite the increasing use of MIS, POI remains a major issue following colorectal surgery. Further strategies to prevent POI are rapidly emerging. Studies using standardised definitions and perioperative care will help validate these interventions and remove barriers to accurate meta-analysis. Future studies should focus on establishing the impact of these interventions on POI after MIS specifically.