Electroacupuncture or transcutaneous electroacupuncture for postoperative ileus after abdominal surgery: A systematic review and meta-analysis

Postoperative ileus (POI) is one of the most common complications after abdominal surgery, characterized by a temporary disturbance of normal bowel motility. This condition manifests through uncomfortable symptoms such as abdominal distension, nausea, vomiting, and difficulty tolerating food. Although most patients recover naturally, POI can significantly prolong length of hospital stay and increase medical costs. Currently, no widely accepted ideal treatment exists for this condition, motivating researchers to seek effective and safe therapeutic alternatives.

Traditional Chinese acupuncture has demonstrated therapeutic potential in the treatment of various gastrointestinal disorders over more than two thousand years of clinical use. Electroacupuncture represents a modern evolution of this ancient technique, combining the traditional principles of acupuncture with low-intensity electrical stimuli applied through the needles. More recently, transcutaneous electroacupuncture has been developed, a noninvasive modality that does not use needles and instead applies electrodes directly on the skin. This latter technique offers important practical advantages, being more readily accepted by patients, portable, and potentially self-administered by the patient at home.

This study represents the first meta-analysis specifically focused on assessing the efficacy of electroacupuncture and transcutaneous electroacupuncture in the treatment of postoperative ileus. The researchers conducted a rigorous systematic review, examining multiple scientific databases for high-quality randomized controlled trials. Fifteen studies involving a total of 965 participants were included, with 489 patients treated with electroacupuncture or transcutaneous electroacupuncture and 476 patients in the control group. All studies were conducted in China, including one in Hong Kong, and involved different types of abdominal surgery such as colorectal, gastrointestinal, and hepatobiliary procedures.

The methodology followed international standards for systematic reviews rigorously, with two independent investigators performing study selection, data extraction, and quality assessment. Researchers analyzed several clinical parameters relevant to assessing the recovery of bowel function, including time to first flatus, first bowel movement, return of bowel sounds, resumption of oral intake, and length of hospital stay. Additionally, a specific analysis was performed in patients undergoing laparoscopic surgery, minimally invasive procedures that have become increasingly popular.

The results of this analysis revealed consistent and statistically significant benefits of electroacupuncture and transcutaneous electroacupuncture across all parameters evaluated. Patients treated with these techniques showed an average reduction of approximately 11.6 hours in time to first flatus, considered one of the main indicators of bowel motility recovery. Time to first bowel movement was reduced on average by 12.9 hours, while return of bowel sounds occurred 7.25 hours earlier. The ability to resume oral intake was advanced by an average of 15.8 hours, and total length of hospital stay was reduced by approximately 1.2 days.

Particularly interesting were the specific results for patients undergoing laparoscopic surgery, who showed even more pronounced benefits. This finding has significant clinical relevance, considering the growing preference for minimally invasive surgical techniques. The most frequently used acupuncture points in the analyzed studies were Zusanli (ST-36), present in virtually all protocols, followed by Shangjuxu (ST-37) and Xiajuxu (ST-39). These points are located on the lateral aspect of the leg and are traditionally associated with regulation of gastrointestinal function in Chinese medicine.

For patients and healthcare professionals, these results suggest that electroacupuncture and transcutaneous electroacupuncture represent valuable therapeutic options for accelerating recovery after abdominal surgery. The safety profile was excellent, with only one minor report of hematoma at the application site across all studies analyzed. Importantly, these techniques did not demonstrate significant analgesic effect, with their benefit being specific to bowel function recovery. Transcutaneous electroacupuncture emerges as particularly promising due to its noninvasive nature and ease of application, characteristics that may facilitate its acceptance and implementation in clinical practice.

However, it is important to acknowledge the limitations identified in this review. The methodologic quality of some studies had deficiencies, particularly related to adequate masking of participants and assessors, which may have influenced the results. Additionally, significant heterogeneity was observed among studies regarding protocols used, types of surgery, and electrical stimulation parameters. The geographic concentration of studies in China also limits the generalizability of results to populations in other regions.

The researchers emphasize the need to establish standardized protocols to optimize the clinical application of these techniques and recommend conducting additional high-quality studies in different geographic and cultural contexts.

In summary, this meta-analysis provides robust evidence that electroacupuncture and transcutaneous electroacupuncture constitute effective and safe treatments for postoperative ileus, offering a valuable complementary approach in postsurgical management. While additional studies are needed to refine protocols and confirm these benefits in more diverse populations, current results are encouraging and suggest that these techniques deserve serious consideration in modern clinical practice.