Free
Original Contribution  |   August 2011
Safety and Efficacy of Immediate Postoperative Feeding and Bowel Stimulation to Prevent Ileus After Major Gynecologic Surgical Procedures
Author Notes
  • From the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at the Pennsylvania State University Milton S. Hershey Medical Center. 
  • Address correspondence to James Fanning, DO, Chief, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Dr Room C-3620, Hershey, PA 17033-2360. E-mail: jfanning1@hmc.psu.edu  
Article Information
Gastroenterology / Obstetrics and Gynecology
Original Contribution   |   August 2011
Safety and Efficacy of Immediate Postoperative Feeding and Bowel Stimulation to Prevent Ileus After Major Gynecologic Surgical Procedures
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 469-472. doi:10.7556/jaoa.2011.111.8.469
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 469-472. doi:10.7556/jaoa.2011.111.8.469
Abstract

Context: Postoperative ileus is a major complication of abdominal surgical procedures

Objective: To evaluate the incidence of ileus and gastrointestinal morbidity in patients who received immediate postoperative feeding and bowel stimulation after undergoing major gynecologic surgical procedures.

Methods: During a 5-year period, the authors tracked demographic, surgical outcome, and follow-up information for 707 patients who underwent major gynecologic operations. All patients received the same postoperative orders, including immediate feeding of a diet of choice and bowel stimulation with 30 mL of magnesium hydroxide (milk of magnesia) twice daily until bowel movements occurred.

Results: Of 707 patients, 6 (<1%) had postoperative ileus. No patients experienced postoperative bowel obstruction and 2 patients (0.3%) had postoperative intestinal leak. No serious adverse effects associated with bowel stimulation were reported.

Conclusion: Immediate postoperative feeding and bowel stimulation is a safe and effective approach to preventing ileus in patients who undergo major gynecologic surgical procedures.

A major complication of abdominal surgical procedures is postoperative ileus (colonic stasis), which results in patient discomfort, prolonged length of hospital stay, and increased cost of treatment.1 Each occurrence of postoperative ileus is estimated to cost $5000 to $10,000, or a total of $1 billion per year in the United States.2 The exact mechanism that produces postoperative ileus is unknown, but possible origins include gastrointestinal inflammatory response, stimulation of the mesenteric plexus, anesthesia, and use of opioid analgesics. The final pathway to postoperative ileus is believed to be associated with activation of the gastrointestinal μ-opioid receptors, which disrupts peristalsis in the rectosigmoid and leads to uncoordinated nonpropulsive contractions. Peristalsis typically returns to normal approximately 3 days after a surgical procedure.3 The incidence of postoperative ileus after gynecologic surgery ranges from 5% to 25%, with the mean incidence being 10% to 15%.4-9 
Immediate postoperative feeding and bowel stimulation has been shown to be effective in preventing postoperative ileus.3 The exact mechanism of early postoperative feeding's effect on ileus is unknown, but possible origins include stimulation of the cephalic-vagal response, stimulation of gastrointestinal hormones (eg, nitric oxide, vasoactive intestinal peptide, substance P), and direct tropic effect. The purpose of bowel stimulation is to directly override rectosigmoid paralysis. 
We have previously reported findings from 2 trials10,11 of early postoperative feeding and bowel stimulation after radical hysterectomy that showed decreased length of stay and no reports of ileus. For the present prospective study, we evaluated the incidence of ileus and gastrointestinal morbidity in all patients who underwent a major gynecologic surgical procedure performed by the senior author (J.F.) during a 5-year study period. All patients received the same postoperative orders, which included immediate feeding and bowel stimulation. To our knowledge, this is the largest trial to evaluate the efficacy of immediate postoperative feeding and bowel stimulation in preventing ileus after major gynecologic surgical procedures. 
Methods
The present prospective study took place during a 5-year period (2004-2009) at 2 hospitals in a major city. During the study period, the senior author (J.F.) entered information for all patients on whom he performed a major gynecologic surgical procedure into a prospective surgical database (Microsoft Excel 2007; Microsoft Corporation, Redmond, Washington). Demographics were obtained and entered preoperatively, surgical outcomes were entered immediately postoperatively, and findings of follow-up examinations were entered for the first 30 days. All patients were examined at 1 and 4 weeks postoperatively. Patients with cancer were also examined every 3 to 6 months for 5 years, but findings of long-term follow-up examinations were not included in the present study. 
Patient inclusion criteria consisted of major gynecologic procedures and included the following: laparoscopic-assisted salpingo-oophorectomy for ovarian masses longer than 15 cm, laparoscopic hysterectomy and lymphadenectomy, laparoscopic hysterectomy for fibroids weighing more than 500 g,15 laparoscopic radical hysterectomy,12 laparoscopic-assisted ovarian debulking,13 laparoscopic ovarian cancer staging,14 modified radical vulvectomy, debulking and bowel resection with laparotomy, ovarian debulking with laparotomy, and vaginal hysterectomy for endometrial cancer in patients weighing more than 350 lb.16 
Postoperative instructions were the same for all patients and were entered into a computerized physician order entry system. These instructions included immediate postoperative feeding of a diet of choice and bowel stimulation with 30 mL of magnesium hydroxide (milk of magnesia) twice daily until bowel movements occurred. No patient had elective postoperative nasogastric tube decompression. All patients received extensive pre- and postoperative education concerning ileus and bowel stimulation, including instructions to eat a diet of choice when hungry and to continue milk of magnesia twice daily until bowel movement. The senior author personally ensured compliance of diet and bowel stimulation on postoperative day 1 rounds. 
All patients underwent a preoperative bowel preparation with 10 oz of magnesium citrate, received a single 500 mg dose of cefazolin sodium if indicated, used pneumatic compression stockings, and performed early ambulation. Unless contraindicated, all patients received ketorolac tromethamine (30 mg intravenously), morphine (2-5 mg intravenously every 2 hours as needed), and acetaminophen and oxycodone hydrochloride (325 mg-5 mg, 1-2 tablets orally every 6 hours as needed) for analgesia after the operation. 
Ileus is defined as the inhibition of bowel motility. The definition of postoperative ileus, however, varies from prolonged absences of flatus to insertion of nasogastric tube decompression to readmission for vomiting.1-9 For the present study, we liberally defined postoperative ileus as either any instance in which a patient's hospital discharge was delayed 1 day or longer because of inadequate oral intake or any instance when a patient was readmitted because of nausea. Because patients were routinely discharged by 9 am the morning after the operation, the time to flatus and bowel movement was not documented. 
Institutional review board approval was obtained for the present study. 
Results
During the 5-year study period, 707 patients met the study criteria. Information for all patients was entered into the database, and no patients were excluded or lost to follow-up. Median age of the 707 patients was 61 years (range, 19-94 years) and median body mass index was 32 kg/m2 (range, 18-76 kg/m2). Six hundred sixty-five patients (94%) were white. Five hundred seventy-three (81%) had medical comorbidities, and 531 (74%) had previously undergone abdominal surgery, pelvic surgery, or both. 
Procedures are presented in Table 1. Three hundred sixty operations (51%) were gynecologic oncology procedures, which included laparoscopic-assisted oophorectomy for ovarian masses longer than 15 cm, laparoscopic hysterectomy and lymphadenectomy, laparoscopic hysterectomy for fibroids weighing more than 500 g,15 laparoscopic radical hysterectomy,12 laparoscopic-assisted ovarian debulking,13 laparoscopic ovarian cancer staging,14 modified radical vulvectomy, debulking and bowel resection with laparotomy, ovarian debulking with laparotomy. The other 357 operations (49%) were gynecologic procedures. Diagnoses are presented in Table 2. Four hundred two patients (56%) had gynecologic cancers, including cervical, endometrial, ovarian, and vulvar. 
Table 1
Major Gynecologic Surgical Procedures (N=707)
Surgical Procedure No.
Laparoscopic-assisted salpingo-oophorectomy for ovarian mass of >15 cm 208
Laparoscopic hysterectomy and lymphadenectomy 160
Laparoscopic-assisted vaginal hysterectomy for fibroids of >500 g 102
Laparoscopic radical hysterectomy 53
Laparoscopic ovarian cancer staging 49
Laparoscopic-assisted ovarian debulking 51
Debulking and bowel resection with laparotomy 23
Ovarian debulking with laparotomy 19
Modified radical vulvectomy 24
Vaginal hysterectomy 18
Table 1
Major Gynecologic Surgical Procedures (N=707)
Surgical Procedure No.
Laparoscopic-assisted salpingo-oophorectomy for ovarian mass of >15 cm 208
Laparoscopic hysterectomy and lymphadenectomy 160
Laparoscopic-assisted vaginal hysterectomy for fibroids of >500 g 102
Laparoscopic radical hysterectomy 53
Laparoscopic ovarian cancer staging 49
Laparoscopic-assisted ovarian debulking 51
Debulking and bowel resection with laparotomy 23
Ovarian debulking with laparotomy 19
Modified radical vulvectomy 24
Vaginal hysterectomy 18
×
Table 2
Diagnoses of Patients Undergoing Major Gynecologic Surgery (N=707)
Diagnosis No.
Ovarian masses of >15 cm 208
Endometrial cancer 178
Ovarian cancer 142
Fibroids of >500 g 102
Vulvar cancer 24
Cervical cancer 53
Table 2
Diagnoses of Patients Undergoing Major Gynecologic Surgery (N=707)
Diagnosis No.
Ovarian masses of >15 cm 208
Endometrial cancer 178
Ovarian cancer 142
Fibroids of >500 g 102
Vulvar cancer 24
Cervical cancer 53
×
Median blood loss was 100 mL (range, 0-800 mL), median operating room time was 1 hour 45 minutes (range, 45 min to 4 h 43 min), and median hospital stay was 1 day (range, 1-7 d). 
Of the 707 patients who underwent surgical procedures, 6 patients had postoperative ileus as defined by the study criteria, with 1 patient experiencing 2 episodes of ileus, for 7 episodes total: 5 patients' hospital discharges were delayed 1 to 2 days after laparoscopic-assisted ovarian debulking, 1 patient's discharge was delayed 2 days after laparoscopic hysterectomy and lymphadenectomy, and 1 patient was readmitted to the hospital for nausea 2 days after laparoscopic-assisted ovarian debulking (this patient was also 1 of the 5 patients whose hospital discharge was delayed 1-2 days, Table 3). All 7 episodes were managed with diet of choice and continued bowel stimulation. 
Table 3
Postoperative Complications in Patients Who Underwent Major Gynecologic Surgery (N=707)
Postoperative Complication No. (%)
Intestinal leak 20 (0.3)
Ileus 7 (1)
Nongastrointestinal morbidity* 2 (13)
Bowel obstruction 0
 *  Included acute tubular necrosis, congestive heart failure, hyponatremia, sarcoid respiratory failure, pulmonary embolism, urinary retention, pneumonia, urinary tract infection, and wound infection.
Table 3
Postoperative Complications in Patients Who Underwent Major Gynecologic Surgery (N=707)
Postoperative Complication No. (%)
Intestinal leak 20 (0.3)
Ileus 7 (1)
Nongastrointestinal morbidity* 2 (13)
Bowel obstruction 0
 *  Included acute tubular necrosis, congestive heart failure, hyponatremia, sarcoid respiratory failure, pulmonary embolism, urinary retention, pneumonia, urinary tract infection, and wound infection.
×
No patients experienced nasogastric tube decompression, serious adverse effects associated with bowel stimulation, or postoperative bowel obstruction. Two patients (0.3%) had postoperative intestinal leak. In both instances, a small perforation of the rectosigmoid colon formed after laparoscopic oophorectomy for an ovarian mass greater than 15 cm. Both events necessitated reoperation. 
Twenty-one patients (3%) had nongastrointestinal morbidity, including acute tubular necrosis, congestive heart failure, hyponatremia, sarcoid respiratory failure, pulmonary embolism, urinary retention, pneumonia, urinary tract infection, and wound infection. 
Comment
The incidence of ileus after gynecologic-oncologic surgical procedures is approximately 15%.4-9 In an effort to prevent ileus, we employed immediate postoperative feeding and bowel stimulation. Even with a liberal definition of postoperative ileus, our study findings showed a 1% incidence of ileus, with no patients requiring nasogastric tube decompression. We believe our low rate of ileus is directly related to immediate feeding and bowel stimulation. 
Another factor that could have contributed to the low rate of postoperative ileus in our study is our emphasis on minimally invasive operations—87% of our surgical procedures were laparoscopic, laparoscopic-assisted, or vaginal. In addition, we used ketorolac tromethamine, which may decrease the gastrointestinal inflammatory response. In 1 prospective randomized trial,17 the use of ketorolac tromethamine statistically significantly reduced the incidence of postoperative ileus in patients who underwent a colorectal surgical procedure. We also believe our extensive pre- and postoperative patient education concerning ileus and bowel stimulation may have allowed patients to better tolerate postoperative intestinal functioning. There were no serious adverse effects associated with bowel stimulation. There were no cases of postoperative bowel obstruction, but there were 2 cases of intestinal leak (0.3%), which required reoperation. 
In a search of the US National Library of Medicine's PubMed database, we were able to locate 4 trials10,11,17,18 of postoperative bowel stimulation (Table 4), including 2 of our trials10,11 that examined postoperative bowel stimulation after radical hysterectomy. In our first trial of bowel stimulation without immediate feeding, mean hospital stay was reduced from 8 days to 4 days.10 In our second trial of bowel stimulation with immediate feeding, mean hospital stay was reduced to 3 days.11 Other studies produced similar findings: a Danish prospective randomized study18 indicated that bowel stimulation decreased time to bowel movement by 35%, and a prospective randomized study19 with patients who underwent colorectal surgical procedures revealed that bowel stimulation reduced length of hospital stay by 1 day. All 4 studies reported no adverse effects from postoperative bowel stimulation. 
Table 4
Findings of Studies on Postoperative Bowel Stimulation
Study No. of Patients Surgery Phase* Agent Results
Fanning10 20 Gynecologic II Magnesium hydroxide LOS decreased 4 d
Fanning11 20 Gynecologic II Sodium phosphate LOS decreased 1 d
Hansen17 53 Gynecologic I Magnesium oxide Gastrointestinal function returned 35% sooner
Zingg18 138 Gastrointestinal I Bisacodyl LOS decreased 1 d
Fanning 707 Gynecologic II Magnesium hydroxide 1% incidence of ileus
 *  Phase I trial: prospective randomized; phase II trial: prospective nonrandomized.
   Present study.
   Compared with typical incidence rate of 10% to 15%.4-9

Abbreviations: LOS, length of hospital stay.

Table 4
Findings of Studies on Postoperative Bowel Stimulation
Study No. of Patients Surgery Phase* Agent Results
Fanning10 20 Gynecologic II Magnesium hydroxide LOS decreased 4 d
Fanning11 20 Gynecologic II Sodium phosphate LOS decreased 1 d
Hansen17 53 Gynecologic I Magnesium oxide Gastrointestinal function returned 35% sooner
Zingg18 138 Gastrointestinal I Bisacodyl LOS decreased 1 d
Fanning 707 Gynecologic II Magnesium hydroxide 1% incidence of ileus
 *  Phase I trial: prospective randomized; phase II trial: prospective nonrandomized.
   Present study.
   Compared with typical incidence rate of 10% to 15%.4-9

Abbreviations: LOS, length of hospital stay.

×
Conclusion
To our knowledge, the present trial is the largest trial to date to evaluate immediate postoperative feeding and bowel stimulation in patients undergoing gynecologic surgical procedures. We believe immediate postoperative feeding and bowel stimulation are safe and effective in the prevention of ileus after gynecologic operations. 
   Financial Disclosures: None reported.
 
References
Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm. 2009;15(6):485-494. [PubMed]
Fitzgerald JE, Ahmed I. Systematic review and meta-analysis of chewinggum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery [published online ahead of print September 10, 2009]. World J Surg. 2009;33:(12)2557-2566. [CrossRef] [PubMed]
Fanning J, Andrews S. Early postoperative feeding after major gynecologic surgery: evidence-based scientific medicine. Am J Obstet Gynecol. 2001;185(1):1-4. [CrossRef] [PubMed]
LaRosa J, Saywell RMJr, Zollinger TW, Oser TL, Erner BK, McClain E. The incidence of adynamic ileus in postcesarean patients. Patient-controlled analgesia versus intramuscular analgesia. J Reprod Med. 1993;38(4):293-300. [PubMed]
Whitehead WE, Bradley CS, Brown MBet al. Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007;197(1):78.el-e7. http://www.ajog.org/article/S0002-9378(07)00283-9/abstract. Accessed July 25, 2011.
Wolff BG, Viscusi ER, Delaney CP, Du W, Techner L. Patterns of gastrointestinal recovery after bowel resection and total abdominal hysterectomy: pooled results from the placebo arms of alvimopan phase III North American clinical trials [published online ahead of print May 17, 2007]. J Am Coll Surg. 2007;205(1):43-51. [CrossRef] [PubMed]
Pearl ML, Valea FA, Fischer M, Mahler L, Chalas E. A randomized controlled trial of early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol. 1998;92(1):94-97. [CrossRef] [PubMed]
Cutillo G, Maneschi F, Franchi M, Giannice R, Scambia G, Benedetti-Panici P. Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: a randomized study. Obstet Gynecol. 1999;93(1):41-45. [CrossRef] [PubMed]
Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group Study [published online ahead of print October 5, 2009]. J Clin Oncol. 2009;27(32):5337-5342. [CrossRef] [PubMed]
Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol. 1999;73(3):412-414. [CrossRef] [PubMed]
Kraus K, Fanning J. Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol. 2000;182(5):996-998. [CrossRef] [PubMed]
Fanning J, Fenton B, Purohit M. Robotic radical hysterectomy. Am J Obstet Gynecol. 2008;198(6):649.e1-e4. http://www.ajog.org/article/S0002-9378(07)02109-6/abstract. Accessed July 25, 2011.
Fanning J, Hojat R, Johnson J, Fenton B. Laparoscopic cytoreduction for primary advanced ovarian cancer. JSLS. 2010;14(1):80-82. [CrossRef] [PubMed]
Trinh H, Ott C, Fanning J. Feasibility of laparoscopic ovarian debulking at recurrence in patients with prior laparotomy debulking. Am J Obstet Gynecol. 2004;190(5):1394-1397. [CrossRef] [PubMed]
Fanning J, Fenton B, Switzer M, Johnson J, Clemons J. Laparoscopically assisted vaginal hysterectomy for uteri weighing 1000 grams or more. JSLS. 2008;12(4):376-379. [PubMed]
Fanning J, Hojat R, Johnson J, Fenton B. Transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese endometrial cancer patients. JSLS. 2010;14(2):183-186. [CrossRef] [PubMed]
Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, Kuo CD. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain. 2009;25(6):485-489. [CrossRef] [PubMed]
Hansen CT, Sorensen M, Moller C, Ottesen B, Kehlet H. Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: a double-blind, placebo-controlled randomized study. Am J Obstet Gynecol. 2007;196(4):311.e1-311.e7. http://www.ajog.org/article/S0002-9378(06)02217-4/abstract. Accessed July 25, 2011.
Zingg U, Miskovic D, Pasternak I, Meyer P, Hamel CT, Metzger U. Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial. Int J Colorectal Dis. 2008;23(12):1175-1183. [CrossRef] [PubMed]
Table 1
Major Gynecologic Surgical Procedures (N=707)
Surgical Procedure No.
Laparoscopic-assisted salpingo-oophorectomy for ovarian mass of >15 cm 208
Laparoscopic hysterectomy and lymphadenectomy 160
Laparoscopic-assisted vaginal hysterectomy for fibroids of >500 g 102
Laparoscopic radical hysterectomy 53
Laparoscopic ovarian cancer staging 49
Laparoscopic-assisted ovarian debulking 51
Debulking and bowel resection with laparotomy 23
Ovarian debulking with laparotomy 19
Modified radical vulvectomy 24
Vaginal hysterectomy 18
Table 1
Major Gynecologic Surgical Procedures (N=707)
Surgical Procedure No.
Laparoscopic-assisted salpingo-oophorectomy for ovarian mass of >15 cm 208
Laparoscopic hysterectomy and lymphadenectomy 160
Laparoscopic-assisted vaginal hysterectomy for fibroids of >500 g 102
Laparoscopic radical hysterectomy 53
Laparoscopic ovarian cancer staging 49
Laparoscopic-assisted ovarian debulking 51
Debulking and bowel resection with laparotomy 23
Ovarian debulking with laparotomy 19
Modified radical vulvectomy 24
Vaginal hysterectomy 18
×
Table 2
Diagnoses of Patients Undergoing Major Gynecologic Surgery (N=707)
Diagnosis No.
Ovarian masses of >15 cm 208
Endometrial cancer 178
Ovarian cancer 142
Fibroids of >500 g 102
Vulvar cancer 24
Cervical cancer 53
Table 2
Diagnoses of Patients Undergoing Major Gynecologic Surgery (N=707)
Diagnosis No.
Ovarian masses of >15 cm 208
Endometrial cancer 178
Ovarian cancer 142
Fibroids of >500 g 102
Vulvar cancer 24
Cervical cancer 53
×
Table 3
Postoperative Complications in Patients Who Underwent Major Gynecologic Surgery (N=707)
Postoperative Complication No. (%)
Intestinal leak 20 (0.3)
Ileus 7 (1)
Nongastrointestinal morbidity* 2 (13)
Bowel obstruction 0
 *  Included acute tubular necrosis, congestive heart failure, hyponatremia, sarcoid respiratory failure, pulmonary embolism, urinary retention, pneumonia, urinary tract infection, and wound infection.
Table 3
Postoperative Complications in Patients Who Underwent Major Gynecologic Surgery (N=707)
Postoperative Complication No. (%)
Intestinal leak 20 (0.3)
Ileus 7 (1)
Nongastrointestinal morbidity* 2 (13)
Bowel obstruction 0
 *  Included acute tubular necrosis, congestive heart failure, hyponatremia, sarcoid respiratory failure, pulmonary embolism, urinary retention, pneumonia, urinary tract infection, and wound infection.
×
Table 4
Findings of Studies on Postoperative Bowel Stimulation
Study No. of Patients Surgery Phase* Agent Results
Fanning10 20 Gynecologic II Magnesium hydroxide LOS decreased 4 d
Fanning11 20 Gynecologic II Sodium phosphate LOS decreased 1 d
Hansen17 53 Gynecologic I Magnesium oxide Gastrointestinal function returned 35% sooner
Zingg18 138 Gastrointestinal I Bisacodyl LOS decreased 1 d
Fanning 707 Gynecologic II Magnesium hydroxide 1% incidence of ileus
 *  Phase I trial: prospective randomized; phase II trial: prospective nonrandomized.
   Present study.
   Compared with typical incidence rate of 10% to 15%.4-9

Abbreviations: LOS, length of hospital stay.

Table 4
Findings of Studies on Postoperative Bowel Stimulation
Study No. of Patients Surgery Phase* Agent Results
Fanning10 20 Gynecologic II Magnesium hydroxide LOS decreased 4 d
Fanning11 20 Gynecologic II Sodium phosphate LOS decreased 1 d
Hansen17 53 Gynecologic I Magnesium oxide Gastrointestinal function returned 35% sooner
Zingg18 138 Gastrointestinal I Bisacodyl LOS decreased 1 d
Fanning 707 Gynecologic II Magnesium hydroxide 1% incidence of ileus
 *  Phase I trial: prospective randomized; phase II trial: prospective nonrandomized.
   Present study.
   Compared with typical incidence rate of 10% to 15%.4-9

Abbreviations: LOS, length of hospital stay.

×