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The authors commend the inclusion of 55 randomized controlled trials yet raise concerns about limited database searching, potential bias, and the need for subgroup analyses comparing open surgery versus minimally invasive surgery. They also discuss surgical site effects on gastrointestinal motility, key mechanisms underlying POI, and the possible role of stellate ganglion block, concluding with acknowledgments.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/letter-to-the-editor-concerns-and-recommendations-on-pharmacologic-prevention-and-therapy-of-postoperative-paralytic-ileus/338047/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/letter-to-the-editor-concerns-and-recommendations-on-pharmacologic-prevention-and-therapy-of-postoperative-paralytic-ileus/338047.png","ImageObject",300,407,{"name":92,"@type":93},"Ezra","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What study does the letter respond to, and what do the authors commend?","Question",{"text":112,"@type":113},"It responds to a systematic review and meta-analysis on pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery. The letter congratulates the authors for their findings and highlights the large number of included randomized controlled trials.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the letter question the methodology of the literature search?",{"text":117,"@type":113},"The letter notes the search was limited to MEDLINE, CENTRAL, and information extracted from ClinicalTrials.gov, without exploring other databases such as Embase, Web of Science, and Scopus. It argues this restricted selection may bias results and conclusions.",{"name":119,"@type":110,"acceptedAnswer":120},"What clinical factors and mechanisms are discussed to explain postoperative paralytic ileus?",{"text":121,"@type":113},"The letter discusses key mechanisms including fluid overload, exogenous opioids, neurohormonal dysfunction, and gastrointestinal stretch/inflammation. It also describes how surgical site and gastrointestinal motility disorders can differ, and mentions stellate ganglion block as part of clinical management.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},338047,1790538404,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},1099514068035,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","’Correspondence  \nLetter to the Editor for the article ‘Pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery – systematic review and meta-analysis’  \nYajie Wang, MDa , Shumin Gao, PhDb , Yisheng Pan, MDa,*  \nDear Editor,  \nWe were interested in reading the impressive study by Reichert et al. [1] in the International Journal of Surgery and would like to congratulate the authors for their interesting findings. Although evidence for pharmacological prevention of postoperative paralytic ileus (POI) following gastrointestinal tumor surgery is limited, authors included 55 RCTs (randomized controlled trials) in this huge meta-analysis, of which 5078 people received the experimental intervention and 3857 people experienced placebo, standard treatment, or no treatment. The author summarizes the approaches to preventing POI, including opioid-sparing analgesia, peripheral opioid antagonism, the reduction of sympathetic hyperreactivity, and early use of laxatives effectively, which is very useful for clinical practice. However, we wish to discuss the following concerns.  \nFirst, the authors limited their literature search to MEDLINE, CENTRAL, as well as information extracted from ClinicalTrials. gov. However, they did not explore other international databases with broad subject areas, including Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases. The selection of a restricted subset of databases for conducting the literature search can lead to biased results and conclusions[2] .  \nSecond, according to our clinical practice and related studies[3-5], compared with minimally invasive surgery (MIS), which includes laparoscopic-assisted surgery and robot-assisted surgery, open surgery (OS) significantly increases the probability of POI. Therefore, it is suggested that the authors conduct a  \naDepartment of Gastrointestinal Surgery, Peking University First Hospital and bNational Institute on Drug Dependence, Peking University, Beijing, People’s Republic of China  \nYajie Wang and Shumin Gao contributed equally to the manuscript.  \nSponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article.  \n*Corresponding author. Address: Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing 100191, People’s Republic of China.  \nTel.: +86 132 953 [196 82. E-mail: yisheng_pan@126.com](196 82. E-mail: yisheng_pan@126.com) (Y. Pan).  \nCopyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms.  \nInternational Journal of Surgery (2024) 110:5258–5259  \nReceived 15 April 2024; Accepted 23 April 2024  \nPublished online 9 May 2024  \n[http://dx.doi.org/10.1097/JS9.0000000000001566](http://dx.doi.org/10.1097/JS9.0000000000001566)  \nsubgroup analysis of different surgical methods (OS or MIS) to ensure more accurate results.  \nThird, we may think about the effect of abdominal surgery at different sites on the occurrence of postoperative POI and on prevention and treatment outcomes. Different parts of gastrointestinal motility disorders produce different clinical manifestations. For example, the main symptoms of gastric dysmotility are concentrated in nausea, vomiting, and upper abdominal distension, while the main symptoms of intestinal motility disorders are abdominal distension, and the mechanisms of the two are also different. POI in gastrectomy can often caused by the removal of motilin[6] and damage to the vagus nerve[7], which activates the movement of the stomach. The impaired interaction between the gut and macrophages during enterectomy is often regarded as the reason for the occurrence of POI[8]","cbCailCoD5inTQ5K","https://ap.wps.com/l/cbCailCoD5inTQ5K","pdf",200850,"English","# Letter to the Editor\n## Summary and praise of the meta-analysis\n## Concerns: database scope and search bias\n## Concerns: open surgery vs minimally invasive surgery subgrouping\n## Additional discussion: surgical site effects and mechanisms of POI\n## Clinical practice perspective: stellate ganglion block and concluding remarks","[{\"question\":\"What study does the letter respond to, and what do the authors commend?\",\"answer\":\"It responds to a systematic review and meta-analysis on pharmacologic prevention and therapy of postoperative paralytic ileus after gastrointestinal cancer surgery. The letter congratulates the authors for their findings and highlights the large number of included randomized controlled trials.\"},{\"question\":\"Why does the letter question the methodology of the literature search?\",\"answer\":\"The letter notes the search was limited to MEDLINE, CENTRAL, and information extracted from ClinicalTrials.gov, without exploring other databases such as Embase, Web of Science, and Scopus. It argues this restricted selection may bias results and conclusions.\"},{\"question\":\"What clinical factors and mechanisms are discussed to explain postoperative paralytic ileus?\",\"answer\":\"The letter discusses key mechanisms including fluid overload, exogenous opioids, neurohormonal dysfunction, and gastrointestinal stretch/inflammation. It also describes how surgical site and gastrointestinal motility disorders can differ, and mentions stellate ganglion block as part of clinical management.\"}]","Letter to the Editor - Concerns and Recommendations on Pharmacologic Prevention and Therapy of Postoperative Paralytic Ileus | PDF",1790021718]