Patients undergoing abdominal surgery experience reduced gastrointestinal (GI) peristalsis due to surgical manipulation of the bowel and post‐operative opioid medication (Litkouhi [107]). The motility of the small intestine is affected to a lesser degree, except in patients who have had small bowel resection or who were operated on to relieve small bowel obstruction (Crainic et al. [45]). GI peristalsis usually returns within 24 hours after most operations that do not involve the abdominal cavity and within 48 hours after laparotomy (Crainic et al. [45]). Prolonged inhibition of GI peristalsis (more than 3 days post‐surgery) is referred to as ‘paralytic ileus’ (Litkouhi [107]). Post‐operative ileus is an abnormal pattern of GI motility whose principal features include a combination of nausea and vomiting, inability to tolerate oral diet, abdominal distention, and delayed passing of flatus or stool (Vather et al. [208]). The duration of post‐operative ileus correlates with the degree of surgical trauma, occurring less frequently following laparoscopic than open surgery (Baig and Wexner [24]). Traditional interventions to prevent post‐operative ileus or stimulate bowel function after surgery include:

Return of peristalsis is often noted by patients as mild cramps, passage of flatus and return of appetite. Unless clinically indicated, both food and enteral feeds should be withheld until there is evidence of the return of normal GI motility.