Feasibility and Safety of an Ileus Management Protocol for Postoperative Ileus After Abdominal Surgery

Feasibility and Safety of an Ileus Management Protocol for Postoperative Ileus

The goal of this clinical trial is to evaluate whether a standardized treatment algorithm, the Ileus Management Protocol (I-MAP), is feasible and safe for the management of patients who develop postoperative ileus (POI) within 30 days after abdominal surgery.

The main questions it aims to answer are:

Can I-MAP be applied consistently, with ≥85% adherence, in eligible patients with POI?

Is the use of I-MAP associated with acceptable safety outcomes, including low rates of complications such as pneumonia, aspiration, and adverse events?

This study does not include a comparison group. All participants are assigned to the I-MAP protocol, and outcomes are evaluated prospectively.

Participants will:

Be monitored for POI symptoms (nausea, vomiting, bloating, absence of gas/stool).

Receive standardized management according to I-MAP, which includes:

Daily assessment of nasogastric tube (NGT) output.

Water-soluble contrast administration via NGT when indicated.

Imaging (CT scan or X-ray) if obstruction is suspected.

Neostigmine administration if small bowel obstruction is excluded.

The primary endpoint is the feasibility of I-MAP, defined as the proportion of POI patients treated according to the algorithm. Secondary outcomes include NGT reinsertion, duration of NGT placement, hospital length of stay, conservative treatment failure, and complications related to POI.

Inclusion Criteria:

• Adults ≥18 years of age.
• Patients who undergo abdominal surgery and develop postoperative ileus (POI) within 30 days.
• Provided general consent for participation.

Exclusion Criteria:

• Preoperative bowel obstruction.
• Anastomotic leak.
• Prophylactic nasogastric tube (NGT) placement.
• Pregnancy.
• Lack of general consent.