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Delayed gastrointestinal recovery after abdominal operation – role of alvimopan

Authors Berger N, Ridolfi TJ, Ludwig K

Received 21 March 2015

Accepted for publication 26 June 2015

Published 5 August 2015 Volume 2015:8 Pages 231—235

DOI https://doi.org/10.2147/CEG.S64029

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Andreas M Kaiser

Nicholas G Berger, Timothy J Ridolfi, Kirk A Ludwig

Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin USA

Abstract: Postoperative Ileus (POI), which occurs after surgical manipulation of the bowel during abdominal operations, is associated with prolonged hospital stay, increasing medical costs, and delayed advancement of enteral diet, which contributes to a significant economic burden on the healthcare system. The use of accelerated care pathways has shown to positively impact gut function, but inevitable postoperative opioid use contributes to POI. Alvimopan is a peripherally acting µ-opioid receptor antagonist designed to mitigate antimotility effects of opioids. In our review, we examined ten trials on alvimopan's use after abdominal operations. Several of the earlier studies on patients undergoing bowel resection showed correlations between the study group and GI recovery as defined by passage of flatus, first bowel movement, and time to readiness for discharge. Data in patients undergoing total abdominal hysterectomy showed similarly decreased GI recovery time. Additionally, data within the past few years shows alvimopan is associated with more rapid GI recovery time in patients undergoing radical cystectomy. Based on our review, use of alvimopan remains a safe and potentially cost-effective means of reducing POI in patients following open GI surgery, radical cystectomy, and total abdominal hysterectomy, and should be employed following these abdominal operations.

Keywords: postoperative ileus, alvimopan, ileus, bowel resection, return of bowel function

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