Gosavi Rathin, Dudi-Venkata Nagendra N, Xu Simon, Asghari-Jafarabadi Mohammad, Wilkins Simon, Nguyen T C, Teoh William, Yap Raymond, McMurrick Paul, Narasimhan Vignesh
Cabrini Monash Department of Surgery, Cabrini Health, Melbourne, Australia.
Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Australia.
Int J Colorectal Dis. 2025 May 29;40(1):131. doi: 10.1007/s00384-025-04924-8.
Postoperative ileus (POI) is a frequent complication after elective colorectal surgery, delaying gastrointestinal (GI) recovery and discharge. While pharmacologic agents such as laxatives and prokinetics are often included in enhanced recovery after surgery (ERAS) protocols, their efficacy and safety remain uncertain.
A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to evaluate the effect of Gastrointestinal (GI) motility agents on postoperative recovery in elective colorectal surgery. Primary outcomes included GI-2 recovery (tolerance of solid diet and stool passage), time to first defaecation, and safety endpoints. Data was pooled using random-effects models.
Seven RCTs involving 849 patients were included. GI motility agents significantly accelerated GI-2 recovery (mean difference -1.01 days; 95% CI -1.29 to -0.73; p < 0.001) and reduced time to first defaecation (mean difference -1.07 days; 95% CI -1.40 to -0.73; p < 0.001). No significant differences were observed in safety outcomes, including anastomotic leak (OR 0.97; 95% CI 0.53 to 1.77), nasogastric tube reinsertion (OR 0.86; 95% CI 0.49 to 1.51), or readmission rates (OR 1.03; 95% CI 0.62 to 1.72).
Motility agents enhance postoperative GI recovery without compromising safety in patients undergoing elective colorectal surgery. Given their low cost, wide availability, and favourable safety profile, gastrointestinal motility agents may be considered for integration into ERAS protocols. However, further high-quality, standardised trials are needed to confirm their benefits across diverse surgical populations.
术后肠梗阻（POI）是择期结直肠手术后常见的并发症，会延迟胃肠道（GI）恢复和出院时间。虽然泻药和促动力药等药物常被纳入术后加速康复（ERAS）方案中，但其疗效和安全性仍不确定。
进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以评估胃肠道（GI）动力药物对择期结直肠手术术后恢复的影响。主要结局包括胃肠道功能2级恢复（耐受固体饮食和排便）、首次排便时间和安全性终点。使用随机效应模型汇总数据。
纳入了7项涉及849例患者的RCT。胃肠道动力药物显著加速了胃肠道功能2级恢复（平均差值-1.01天；95%置信区间-1.29至-0.73；p<0.001），并缩短了首次排便时间（平均差值-1.07天；95%置信区间-1.40至-0.73；p<0.001）。在安全性结局方面未观察到显著差异，包括吻合口漏（比值比0.97；95%置信区间0.53至1.77）、重新插入鼻胃管（比值比0.86；95%置信区间0.49至1.51）或再入院率（比值比1.03；95%置信区间0.62至1.72）。
动力药物可促进择期结直肠手术患者术后胃肠道恢复，且不影响安全性。鉴于其成本低、易于获得且安全性良好，胃肠道动力药物可考虑纳入ERAS方案。然而，需要进一步的高质量、标准化试验来证实其在不同手术人群中的益处。
