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[Immunomodulatory aspects in the development, prophylaxis and therapy for postoperative ileus].

Authors
  • Vilz, T O
  • Wehner, S
  • Pantelis, D
  • Kalff, J C
Type
Published Article
Journal
Zentralblatt für Chirurgie
Publication Date
Aug 01, 2014
Volume
139
Issue
4
Pages
434–444
Identifiers
DOI: 10.1055/s-0033-1350678
PMID: 24327489
Source
Medline
License
Unknown

Abstract

Postoperative ileus (POI) is defined as a transient episode of impaired gastrointestinal motility after abdominal surgery, which prevents effective transit of intestinal contents or tolerance of oral intake. This frequent postoperative complication is accompanied by a considerable increase in morbidity and hospitalisation costs. The aetiology of POI is multifactorial. Besides a suppression of peristalsis by inhibitory neuronal signalling and administration of opioids, particularly in the prolonged form, immunological processes play an important role. After surgical trauma, resident macrophages of the muscularis externa (ME) are activated leading to the liberation of proinflammatory mediators and a spreading of the inflammation along the entire gastrointestinal tract. To date, no prophylaxis or evidence-based single approach exists to treat POI. Since none of the current treatment approaches (i.e., prokinetic drug treatment) has provided a benefit in randomised trials, immunoregulatory interventions appear to be more promising in POI prevention or treatment. The present contribution gives an overview of immunological mechanisms leading to POI focusing on current and future therapeutic and prophylactic approaches.

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