Post-operative Ileus.....

OK, so this posting isn't about anything political or social.


And no, I'm not a medical expert by any stretch of the imagination.


What I am is a son who has watched his father go through more surgeries during his lifetime than any person should have to undergo.  An average of one major surgery every one-and-a-half years for the last 40 years.  Back.  Knees.  Wrists.


The long surgeries all have one thing in common - post-surgical ileus.


Getting the digestive tract working again after receiving anesthesia for several hours is a problem faced by thousands of patients every day.  And despite the best efforts of medicos to treat this problem pharmacologically, for many patients the problem will persist for days on end - the most serious cases resulting in even more surgery to correct the digestive tract complications that can occur.  Medicines, suppositories, enemas, all are tried in an effort to get the ol' poop shoot working again, but for many, these measures are insufficient.


Such was the case of my father with his most recent surgery.  After spending nearly eight hours on the operating table for his most recent back surgery, he suffered from a severe case of post-operative ileus.  Doctors, including a professor of gastroenterology, tried everything for nearly a week to kick-start his system.  Everything they tried failed.  One morning, I received a call from dad.  To say that he was in distress would be an understatement.  I asked him for the exact diagnosis of his condition - post-operative ileus - and then began digging.   I found a paper in the American Medical Association archives relating to post-operative ileus.  There was the usual discussion of the nature of the problem, and a significant portion of the paper was devoted to pharmacological intervention.  But buried in the paper was a section dealing with non-pharmacological remedies for this condition.  And that is where we got our answers.


You see, post-operative ileus is the result of several factors.  


First, the patient is typically required to fast for 12 to 24 hours prior to major surgery.  Nothing is remaining in the stomach, and most of the contents of the intestines are passed.  This means that there is nothing remaining to stimulate the muscles of the digestive tract to function properly.


Second, the intestinal tract is home to beneficial bacterial flora which aid in the digestion of food.  When the digestive tract is emptied during fasting, those bacteria begin to die off - meaning that the ability of the digestive tract to function properly is also compromised.  What isn't killed off during the famine known as fasting is finished off by the drugs that are administered during the course of a surgery.


Third, anesthesia does more than put one's lights out; it can paralyze muscles in the digestive tract, as well.  Somehow, those muscles must be re-awakened.


So what can one do to reduce the likelihood of a prolonged bout of post-operative ileus?  What I provide here is based mostly on our own observations of what has proven effective.


First, as soon as possible after surgery, begin chewing gum.  Yes, that's right.  Chew gum.  While one may be on a highly restricted diet immediately after surgery, even relying on IVs to deliver nutrition and hydration, chewing gum initiates the flow of digestive juices throughout the digestive system.  It is a placebo for the digestive system.  Chewing gum three times a day for an hour beginning postoperative day one begins the flow of digestive juices and can produce significant results.  In a randomized, prospective, controlled study on gum chewing as a method to stimulate bowel motility after laparo-scopic colectomy for colorectal cancer, the patients who chewed gum 3 times a day starting postoperative day one until oral intake experienced the passage of first flatus an average of 1.1 days earlier than the control group (day 2.1 vs 3.2). The first bowel movement for gum-chewing patients occurred by post-operative day 3.1, versus postoperative day 5.8 for the control group (Mechanisms and Treatment of Postoperative Ileus, Andrew Luckey, MD; Edward Livingston, MD; Yvette Tache ́, PhD, p 211).


Second, increase intake of fiber.  Fiber stimulates the muscles of the bowels and goes a long way to insure bowel health and proper function.


Third, as soon as possible, begin intake of pro-biotics, particularly acidophilus.   As was observed previously, drugs administered during surgery kill beneficial bacterial flora in the gut; taking pro-biotics repopulates the digestive tract with the beneficial bacterial flora that is so necessary to effective digestion.


In our experience, the combination of these three things can bring about a much more speedy resolution to the problem of post-surgical ileus.