Editorial
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 14, 2010; 16(14): 1683-1687
Published online Apr 14, 2010. doi: 10.3748/wjg.v16.i14.1683
Controlling postoperative ileus by vagal activation
Tim Lubbers, Wim Buurman, Misha Luyer
Tim Lubbers, Wim Buurman, Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, 6200 MD, Maastricht, The Netherlands
Misha Luyer, Department of Surgery, Orbis Medical Center, 6162 BG, Sittard, The Netherlands
Author contributions: Lubbers T, Buurman W and Luyer M contributed equally to this paper.
Supported by DANONE Research Centre for Specialised Nutrition, Wageningen, the Netherlands and by AGIKO-stipendia 920-03-522 (to Lubbers T) and 920-03-271 (to Luyer M) from the Netherlands Organization for Health Research and Development
Correspondence to: Misha Luyer, MD, PhD, Department of Surgery, Orbis Medical Center, 6162 BG, Sittard, The Netherlands. m.luyer@ah.unimaas.nl
Telephone: +31-99-4591818 Fax: +31-99-4591818
Received: December 8, 2009
Revised: January 25, 2010
Accepted: February 1, 2010
Published online: April 14, 2010
Abstract

Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiological intervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay.

Keywords: Postoperative ileus; Inflammation; Vagus; Nutritional antiinflammatory pathway