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Post-Operative Ileus After Digestive Surgery: Network Meta-Analysis of Pharmacological Intervention.
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  • Etienne Buscail,
  • Thibault Planchamp,
  • Guillaume Le Cosquer ,
  • Manon Bouchet,
  • Julie Thevenin,
  • Nicolas Carrere,
  • Fabrice Muscari,
  • Olivier Abbo,
  • Charlotte Maulat,
  • Ariane Weyl,
  • Jean Pierre Duffas,
  • Laurent Ghouti,
  • Cindy Canivet,
  • Antoine Philis,
  • Jean Paul Motta,
  • Nathalie Vergnolle,
  • Celine Deraison,
  • Jason Shourick
Etienne Buscail
University Hospital Centre Toulouse

Corresponding Author:[email protected]

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Thibault Planchamp
University Hospital Centre Toulouse
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Guillaume Le Cosquer
University Hospital Centre Toulouse
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Manon Bouchet
University Hospital Centre Toulouse
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Julie Thevenin
Institut de recherche en santé digestive
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Nicolas Carrere
University Hospital Centre Toulouse
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Fabrice Muscari
University Hospital Centre Toulouse
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Olivier Abbo
University Hospital Centre Toulouse
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Charlotte Maulat
University Hospital Centre Toulouse
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Ariane Weyl
University Hospital Centre Toulouse
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Jean Pierre Duffas
University Hospital Centre Toulouse
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Laurent Ghouti
University Hospital Centre Toulouse
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Cindy Canivet
University Hospital Centre Toulouse
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Antoine Philis
University Hospital Centre Toulouse
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Jean Paul Motta
Institut de recherche en santé digestive
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Nathalie Vergnolle
Institut de recherche en santé digestive
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Celine Deraison
Institut de recherche en santé digestive
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Jason Shourick
University Hospital Centre Toulouse
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Abstract

Background: Several medicinal treatments for avoiding post-operative ileus (POI) after abdominal surgery have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different treatments on ileus outcome measures. Methods: A systematic literature review was performed to identify randomised controlled trials (RCTs) comparing treatments for post-operative ileus following abdominal surgery. A Bayesian network meta-analysis was performed. Direct and indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis. Results: A total of 38 randomised controlled trials were included in this network meta-analysis reporting on 6371 patients. Our network meta-analysis shows that prokinetics significantly reduce the duration of first gas (Mean difference (MD) (hours) – 16; credible interval - 30, - 3.1; surface under the cumulative ranking curve (SUCRA) 0.418), duration of first bowel movements (Mean difference (MD) (hours) -25; credible interval - 39, - 11; SUCRA 0.25) and duration of post-operative hospitalisation (Mean difference (MD) (hours) – 1.9; credible interval – 3.8, - 0.040; SUCRA 0.34). Opioid antagonists are the only treatment that significantly improve the duration of food recovery (Mean difference (MD) (hours) - 19; credible interval - 26, - 14; SUCRA 0.163). Conclusion: Based on our meta-analysis, the two most consistent pharmacological treatments able to effectively reduce POI after abdominal surgery are prokinetics and opioid antagonists. The absence of clear superiority of one treatment over another highlights the limits of the pharmacological principles available.
28 Mar 2023Submitted to British Journal of Clinical Pharmacology
28 Mar 2023Submission Checks Completed
28 Mar 2023Assigned to Editor
31 Mar 2023Review(s) Completed, Editorial Evaluation Pending
05 Apr 2023Reviewer(s) Assigned
04 May 2023Editorial Decision: Revise Minor
21 May 20231st Revision Received
21 May 2023Submission Checks Completed
21 May 2023Assigned to Editor
21 May 2023Review(s) Completed, Editorial Evaluation Pending
01 Jun 2023Editorial Decision: Revise Major
15 Jul 20232nd Revision Received
16 Jul 2023Submission Checks Completed
16 Jul 2023Assigned to Editor
16 Jul 2023Review(s) Completed, Editorial Evaluation Pending
18 Jul 2023Editorial Decision: Accept