Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery

Aurélien Venara (1, 2, 3) , Karem Slim (4) , Jean-Marc Régimbeau (5) , Pablo Ortega-Deballon (6) , Bruno Vielle (1) , Emilie Lermite (1, 2) , Guillaume Meurette (7, 3) , Antoine Hamy (1, 2)

1 CHU Angers - Centre Hospitalier Universitaire d'Angers
2 UNAM - PRES Université Nantes Angers Le Mans
3 TENS - The Enteric Nervous System in gut and brain disorders [U1235]
4 CHU Estaing [Clermont-Ferrand]
5 CHU Amiens-Picardie
6 Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
7 CHU Nantes - Centre Hospitalier Universitaire de Nantes

PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification. METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons. RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations. CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.

Mots clés: Postoperative ileus; Postoperative morbidity; Classification

Domaines: Hépatologie et Gastroentérologie; Chirurgie

Aurélien Venara, Karem Slim, Jean-Marc Régimbeau, Pablo Ortega-Deballon, Bruno Vielle, et al.. Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery. International Journal of Colorectal Disease, 2017, 32 (6), pp.797-803. ⟨10.1007/s00384-017-2788-6⟩. ⟨hal-01556424⟩