---
title: "Postoperative ileus"
url: "https://acuiq.com/wiki/evidence/postoperative-ileus"
updated: 2026-10-10
last_verified: 2026-10-10
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-10"
reading_minutes: 9
sources: 14
---

# Postoperative ileus

_What five systematic reviews, seven trials against sham, usual care and standard care, and the 2025 ERAS colorectal guideline report on acupuncture for the recovery of bowel function after abdominal surgery._

Postoperative ileus is the pause in the gut’s movement after an operation, which stops food and gas passing and brings bloating, pain, nausea and vomiting. The [2025 colorectal guideline of the Enhanced Recovery After Surgery (ERAS) Society](https://doi.org/10.1016/j.surg.2025.109397) describes it as common after bowel surgery and usually self-limiting, and says a prolonged ileus lengthens the hospital stay, raises the risk of infection and slows recovery. Trials of acupuncture for it count hours: the time from the end of surgery to the first passing of gas (flatus) and the first bowel movement (defecation). Most use electroacupuncture, in which a small current runs between needles, given once a day for the first few days after surgery. Since 2013 most sham-controlled trials, the larger ones after laparoscopic (keyhole) cancer surgery, have reported first flatus or defecation brought forward by about 11 to 22 hours against sham, and the 2025 ERAS guideline lists acupuncture among the measures that may be used.

## No Cochrane review

The Cochrane Library holds no review of acupuncture for postoperative ileus as of October 2026. It has reviewed [chewing gum after surgery](https://doi.org/10.1002/14651858.CD006506.pub3) by Short and colleagues in 2015, which pooled 81 studies with 9,072 participants and found gum shortened the time to first flatus by 10.4 hours and to first bowel movement by 12.7 hours; it is a reference point for the size of the effects below, not a review of acupuncture.

## Later reviews

Five systematic reviews cover the trials. They differ in which operations and which controls they admit, so the table keeps them apart. Sham acupuncture here means shallow needles at points away from the classical ones, or electrodes with no current; usual care means the hospital’s standard recovery programme without any needling.

| Review | Trials and people | Comparison | Finding | Certainty |
| --- | --- | --- | --- | --- |
| [Liu and colleagues, 2018](https://doi.org/10.1155/2018/3178472), colorectal cancer surgery | 22 trials, 1,628 people | Sham (5 trials) and unblinded controls | Shorter time to first bowel sounds, flatus and defecation in both groups of trials | Not graded; the authors call 4 blinded trials good quality |
| [Ye and colleagues, 2022](https://doi.org/10.1371/journal.pone.0271580), gastrointestinal surgery | 18 trials, 1,413 people | Usual care; sham | Shorter time to flatus, defecation and bowel sounds, and shorter stay, against usual care; against sham the result did not hold up in sensitivity analysis | Very low to moderate |
| [Chen and colleagues, 2024](https://doi.org/10.1097/JS9.0000000000000848), colorectal surgery, electroacupuncture only | 16 trials, 1,562 people | Standard care | Flatus 10.1 hours sooner, defecation 11.8 hours sooner, stay 1.2 days shorter, fewer complications (risk ratio 0.71) | Not stated in the abstract |
| [Yuan and colleagues, 2024](https://doi.org/10.1111/jgh.16670), abdominal surgery, electroacupuncture only | 14 trials, 1,105 people | Usual care; sham | Defecation 12.7 hours sooner than usual care and 10.8 hours sooner than sham; no firm answer on hospital stay or prolonged ileus | Trial sequential analysis called the defecation and flatus results firm |
| [Zhu and colleagues, 2026](https://doi.org/10.1097/MD.0000000000047305), cancer surgery | 11 trials, 1,923 people | Sham only | Shorter time to flatus, defecation and bowel sounds; electroacupuncture did not shorten the hospital stay against sham | Not stated in the abstract; adverse events underreported |

Yuan’s review used trial sequential analysis, which asks whether the pooled trials hold enough people to trust a result; it found enough for time to defecation and flatus and too few to say whether electroacupuncture prevents a prolonged ileus. Liu’s review found the strongest evidence for electroacupuncture at [`ST36`](/points/ST36) (Zusanli), and it is the review the ERAS guideline cites.

## Landmark trials

- **Usual care, 2010.** A [trial at Fudan University Cancer Hospital](https://pmc.ncbi.nlm.nih.gov/articles/PMC2799905/) in Shanghai by Meng and colleagues randomised 90 people after abdominal surgery for colon cancer to daily electroacupuncture for up to 6 days or usual care. It found no difference in prolonged ileus, defined as no flatus or bowel movement by 96 hours, or in quality of life.
- **Sham and no treatment, 2013.** A [trial in Hong Kong](https://doi.org/10.1053/j.gastro.2012.10.050) by Ng and colleagues randomised 165 people having laparoscopic surgery for colon or upper rectal cancer to electroacupuncture, sham acupuncture or no acupuncture, once a day on days 1 to 4, at `ST36`, [`SP06`](/points/SP06) (Sanyinjiao), [`LI04`](/points/LI04) (Hegu) and [`TB06`](/points/TB06) (Zhigou). Time to defecation averaged 85.9 hours with electroacupuncture, 107.5 with sham and 122.1 with none, and the electroacupuncture group also needed less pain relief.
- **Sham, 2013.** A [trial at Memorial Sloan Kettering Cancer Center](https://doi.org/10.1245/s10434-012-2759-7) in New York by Deng and colleagues gave 90 people after colectomy for colon cancer true or sham acupuncture twice a day for 3 days. Recovery, measured as the later of tolerating solid food and first flatus or bowel movement, took 149 hours with acupuncture and 146 with sham. The authors note the spread of results was far wider than planned for, so a larger trial might be needed.
- **Stimulation through the skin, 2021.** A [trial in 10 Chinese hospitals](https://doi.org/10.1016/j.surg.2021.08.007) by Gao and colleagues gave 610 people having colorectal surgery transcutaneous electrical acupoint stimulation, a current through skin pads with no needles, at `ST36`, [`ST37`](/points/ST37) (Shangjuxu) and `SP06`, or the same pads with no current. Ileus, defined as no flatus for more than 72 hours, affected 32.3% against 41.0%.
- **One point against another, 2022.** A [single-centre trial in Beijing](https://doi.org/10.1016/j.eclinm.2022.101472) by Yang and colleagues randomised 105 people after laparoscopic colorectal cancer surgery to electroacupuncture at `ST36`, electroacupuncture at [`ST25`](/points/ST25) (Tianshu), or standard care alone. `ST36` shortened the time to flatus and to defecation against standard care; `ST25` did not.
- **Sham, within an ERAS programme, 2023.** A [multicentre trial in China](https://doi.org/10.1001/jamasurg.2022.5674) by Wang and colleagues, published in JAMA Surgery, randomised 249 people having laparoscopic colorectal cancer surgery under an ERAS protocol to four daily sessions of electroacupuncture at [`CV12`](/points/CV12) (Zhongwan), `ST25`, `ST36` and `ST37`, or sham needling at non-acupoints with the current cut. Median time to first defecation was 76.4 hours against 90.0, and prolonged ileus affected 10% against 20% (risk ratio 0.51). Hospital stay and readmission did not differ, and no serious adverse event occurred. The authors list as limitations that patients’ expectations differed between groups, that the trial ran in a culture that expects acupuncture to work, and that compliance with the ERAS protocol was not measured.
- **Sham and standard care, gastric surgery, 2025.** A [trial in 7 Chinese hospitals](https://doi.org/10.1053/j.gastro.2025.02.006) by Pei and colleagues, published in Gastroenterology, randomised 585 people having laparoscopic gastrectomy for stomach cancer to four sessions of electroacupuncture, sham electroacupuncture or standard care. Electroacupuncture brought first flatus 13.0 hours sooner than sham and 24.5 hours sooner than standard care, and lowered the rate of prolonged ileus against both. No severe adverse event was reported.

## What guidelines say

The [ERAS Society’s guideline for elective colorectal surgery](https://doi.org/10.1016/j.surg.2025.109397), by Gustafsson and colleagues, was published in Surgery in June 2025, follows the 2018 edition and is the newest colorectal guideline on the Society’s list in October 2026. Its recommendation on ileus is a multimodal approach, graded strong, and its table of individual measures rates acupuncture as effective at shortening the time to flatus and first defecation, on low-quality evidence, with the recommendation “may be used (weak)”. It gives the same rating to acupuncture combined with simo decoction, a herbal drink. Transcutaneous electrical acupoint stimulation, on the strength of the Gao trial, is rated moderate quality with “can be used (moderate)”, the same grade as chewing gum. For acupuncture the guideline cites the 2018 Liu review; it does not cite the 2023 Wang trial or the 2025 Pei trial.

## What the reviews could not settle

Nearly every trial in these reviews ran in China. Meng’s trial in Shanghai and Deng’s in New York found no benefit, and both were small. The Wang trial’s authors ask for their result to be extended to other countries with caution. Yuan’s analysis found the trials too few to show whether electroacupuncture prevents a prolonged ileus, and Zhu’s review found electroacupuncture did not shorten the hospital stay against sham. The large trials are of laparoscopic surgery for bowel and stomach cancer, so they say nothing directly about open surgery or operations for other conditions, and Zhu’s review found adverse events reported too seldom to judge safety in full. [Yang’s trial](https://doi.org/10.1016/j.eclinm.2022.101472) found `ST25` made no difference where `ST36` did, and which points matter has not been tested at scale.

[Sham acupuncture](/wiki/research/sham-acupuncture) explains what a sham control can and cannot rule out. [Nausea after surgery](/wiki/evidence/nausea-after-surgery) and [postoperative pain](/wiki/evidence/postoperative-pain) report the trials in two other problems of recovery, and [constipation](/wiki/evidence/constipation) those in chronic slow bowels. AcuiQ’s [postoperative ileus](/symptoms/ileus-postoperative) and [postoperative gastrointestinal dysfunction](/symptoms/gastrointestinal-dysfunction-postoperative) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Gustafsson UO, Rockall TA, Wexner S, et al., Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025, Surgery 2025 — https://doi.org/10.1016/j.surg.2025.109397
2. Short V, Herbert G, Perry R, et al., Chewing gum for postoperative recovery of gastrointestinal function, Cochrane Database of Systematic Reviews 2015 — https://doi.org/10.1002/14651858.CD006506.pub3
3. Liu Y, May BH, Zhang AL, Guo X, Lu C, Xue CC, Zhang H, Acupuncture and related therapies for treatment of postoperative ileus in colorectal cancer: a systematic review and meta-analysis of randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2018 — https://doi.org/10.1155/2018/3178472
4. Ye Z, Wei X, Feng S, et al., Effectiveness and safety of acupuncture for postoperative ileus following gastrointestinal surgery: a systematic review and meta-analysis, PLoS One 2022 — https://doi.org/10.1371/journal.pone.0271580
5. Chen HT, Hung KC, Huang YT, et al., Efficacy of electroacupuncture in improving postoperative ileus in patients receiving colorectal surgery: a systematic review and meta-analysis, International Journal of Surgery 2024 — https://doi.org/10.1097/JS9.0000000000000848
6. Yuan L, Quan SJ, Li XY, Huang YB, Li YQ, Zheng H, Effectiveness of electroacupuncture on postoperative ileus prevention after abdominal surgery: a systematic review and trial sequential analysis of randomized controlled trials, Journal of Gastroenterology and Hepatology 2024 — https://doi.org/10.1111/jgh.16670
7. Zhu M, Chen L, Peng X, Liu M, Liu Y, Liu W, A systematic review and meta-analysis of acupuncture versus sham/placebo acupuncture for postoperative gastrointestinal dysfunction in cancer patients, Medicine 2026 — https://doi.org/10.1097/MD.0000000000047305
8. Meng ZQ, Garcia MK, Chiang JS, et al., Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial, World Journal of Gastroenterology 2010 — https://pmc.ncbi.nlm.nih.gov/articles/PMC2799905/
9. Ng SSM, Leung WW, Mak TWC, et al., Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer, Gastroenterology 2013 — https://doi.org/10.1053/j.gastro.2012.10.050
10. Deng G, Wong WD, Guillem J, et al., A phase II, randomized, controlled trial of acupuncture for reduction of postcolectomy ileus, Annals of Surgical Oncology 2013 — https://doi.org/10.1245/s10434-012-2759-7
11. Gao W, Li W, Yan Y, et al., Transcutaneous electrical acupoint stimulation applied in lower limbs decreases the incidence of paralytic ileus after colorectal surgery: a multicenter randomized controlled trial, Surgery 2021 — https://doi.org/10.1016/j.surg.2021.08.007
12. Yang JW, Shao JK, Wang Y, et al., Effect of acupuncture on postoperative ileus after laparoscopic elective colorectal surgery: a prospective, randomised, controlled trial, EClinicalMedicine 2022 — https://doi.org/10.1016/j.eclinm.2022.101472
13. Wang Y, Yang JW, Yan SY, et al., Electroacupuncture vs sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: a multicenter, randomized clinical trial, JAMA Surgery 2023 — https://doi.org/10.1001/jamasurg.2022.5674
14. Pei L, Wang G, Yang S, et al., Electroacupuncture reduces duration of postoperative ileus after laparoscopic gastrectomy for gastric cancer: a multicenter randomized trial, Gastroenterology 2025 — https://doi.org/10.1053/j.gastro.2025.02.006