Controlling postoperative ileus by vagal activation

作     者：Tim Lubbers Wim Buurman Misha Luyer 

作者机构：Department of Surgery NUTRIM School for Nutrition Toxicology and Metabolism Maastricht University Medical Center 6200 MD Maastricht The Netherlands Department of Surgery Orbis Medical Center 6162 BG Sittard The Netherlands 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2010年第16卷第14期

页      面：1683-1687页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Supported by DANONE Research Centre for Specialised Nutrition, Wageningen, the Netherlands 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 

主　　题：Postoperative ileus Inflammation Vagus Nutritional antiinflammatory pathway 

摘      要：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 physiologicalintervention 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.