Effectiveness and safety of acupuncture for postoperative ileus following gastrointestinal surgery: A systematic review and meta-analysis

## What Postoperative Ileus Is and Why This Study Matters

Postoperative ileus is a very common complication after gastrointestinal surgery, affecting about 24% of patients undergoing bowel operations. This condition consists of temporary intestinal paralysis, causing symptoms such as abdominal distension, pain, delayed passage of gas and stool, nausea, and vomiting. In addition to patient discomfort, postoperative ileus prolongs hospital stay and significantly increases healthcare costs, reaching $1.5 billion annually in the United States alone.

Conventional treatment includes basic care such as nasogastric tubes, intravenous hydration, parenteral nutrition, and early mobilization, but the efficacy of these measures is controversial. Therefore, there is great interest in finding complementary alternatives that can accelerate bowel function recovery. Acupuncture, a long-standing practice from Chinese medicine that stimulates specific points to correct energetic imbalances in the body, emerges as a promising option due to its nonpharmacological and minimally invasive characteristics.

## How This Research Was Conducted

This study represents a systematic review and meta-analysis — that is, a rigorous analysis that gathered and combined the results of multiple prior research studies to obtain more robust conclusions. The researchers searched seven major medical databases, including Chinese and Western databases, looking for randomized controlled trials published through May 2021.

Only studies that compared acupuncture with conventional care or sham acupuncture in adult patients after gastrointestinal surgery were included. The methodological quality of each study was assessed using standardized Cochrane Collaboration tools, and the overall certainty of evidence was graded using the GRADE system. The researchers analyzed primarily four outcomes: time to first passage of gas, time to first bowel movement, time to return of bowel sounds, and length of hospital stay.

## Main Study Findings

The analysis included 18 studies involving 1,413 participants from different countries, with most from China but also including research from Korea and the United States. The results showed consistent benefits of acupuncture compared with conventional care. Time to first passage of gas was significantly reduced, as was time to first bowel movement. Return of bowel sounds, which indicates recovery of normal digestive function, also occurred more quickly in the acupuncture group.

A particularly relevant finding was the 1.68-day reduction in length of hospital stay, which represents not only benefits for the patient in terms of comfort and faster recovery, but also potentially significant savings for the healthcare system. When compared with sham acupuncture, true acupuncture also showed advantages, although these results should be interpreted more cautiously due to the smaller number of available studies.

Subgroup analysis revealed that the combination of distal points (away from the abdomen) and once-daily treatment were the most effective approaches. The most commonly used points were ST-36, ST-37, and SP-6, located primarily on the legs, following the principles of traditional Chinese medicine for the treatment of digestive problems.

## What This Means for Patients and Providers

For patients undergoing gastrointestinal surgery, these results suggest that acupuncture can be a valuable tool for accelerating recovery and reducing postoperative discomfort. The technique was shown to restore normal bowel functions more quickly, allowing earlier return to oral feeding and faster hospital discharge. This translates into less suffering, more comfortable recovery, and faster return to normal activities.

For healthcare providers, the findings indicate that acupuncture can be incorporated as part of postoperative recovery protocols. The reduction in length of stay may represent substantial savings in hospital resources and improved patient flow. The technique is relatively safe, with few adverse events reported in the analyzed studies, the most common being only minor bruising at the application site.

Clinicians should consider that acupuncture works through mechanisms that include activation of the parasympathetic nervous system, reduction of intestinal inflammation, and facilitation of recovery of intestinal pacemaker cells. These mechanisms complement conventional care and may be especially useful in patients at higher risk of developing prolonged ileus.

## Important Limitations and Considerations

Despite the promising results, this study has some important limitations that should be considered. The overall quality of the evidence was rated as very low to moderate, primarily due to methodological problems in the original studies. Many studies were unable to adequately implement blinding of participants and assessors, which may have biased the results in favor of acupuncture.

Most of the studies were conducted in Asian, particularly Chinese, populations, which may limit the applicability of the results to other populations and cultural contexts. There is also significant heterogeneity between studies in terms of techniques used, points selected, and treatment protocols, making it difficult to determine the most effective approach.

Another important point is that relatively few studies reported information on safety and adverse events, leaving some questions about the safety profile of acupuncture in this context not fully clarified. Although the events reported were mild, a more systematic safety assessment would be desirable.

Finally, the researchers emphasize the need for high-quality future studies, with larger samples and multicenter designs, to confirm these findings and establish standardized treatment protocols. It would also be valuable to investigate the potential economic benefits of reduced length of stay and to determine which specific point combinations and treatment frequencies are most effective for different types of digestive surgery.