Electroacupuncture and Postoperative Ileus: Which Benefits Held Up Against Sham Treatment
After abdominal surgery, the bowel tends to stop working for a while. Nothing moves, nothing passes, eating is uncomfortable or impossible, and everyone waits. Surgeons call it postoperative ileus, and it is one of the main reasons a person stays in the hospital longer than the operation itself required. There is no reliably effective drug for it.
That is the setting for a new randomized trial testing electroacupuncture [1], and it is a setting where I have a professional stake, because I am a licensed acupuncturist as well as a naturopathic physician. That is a reason to be especially careful describing what this trial did and did not show.
What the researchers found
Researchers at a hospital in Nanjing enrolled 115 adults having radical resection of colorectal cancer (surgery to remove the cancer along with surrounding tissue), and 101 completed treatment and were analyzed [1]. Participants received either electroacupuncture or sham electroacupuncture, an imitation treatment designed to look and feel like the real one. Sessions started two hours after surgery and were repeated on the mornings of the first two days after, 30 minutes each time.
The primary outcome was time to first flatus (passing gas), which is the standard marker that bowel function has resumed. That improved in the electroacupuncture group. So did time to first oral feeding and time to bowel sound recovery. Length of postoperative hospital stay did not differ between the groups.
The trial also measured markers related to mechanism. Interleukin-1β, a signaling protein that drives inflammation, was lower in the electroacupuncture group on day one after surgery, and both interleukin-1β and interleukin-6 were lower on day three. Two heart rate variability measures, pNN50 and high-frequency power, were higher in the electroacupuncture group. Both are indicators of parasympathetic activity, which is the branch of the autonomic nervous system that turns digestion back on.
The authors list their own limitations plainly, and they bear repeating: single center, small sample, no long-term follow-up, and no untreated control group alongside the sham [1].
How this fits with the earlier trials
Earlier research tested the same treatment after the same kind of surgery, and comparing this trial with it shows which results were consistent.
In 2023, JAMA Surgery published a multicenter, sham-controlled trial of the same intervention in the same population [2]. 248 patients undergoing laparoscopic colorectal cancer resection were randomized to four sessions of electroacupuncture or sham, all within an Enhanced Recovery After Surgery protocol (a standard hospital plan for speeding recovery after an operation). Median time to first defecation was 76.4 hours with electroacupuncture and 90.0 hours with sham, a difference of about nine hours. Time to first flatus improved from a median of 58.9 to 44.3 hours. Prolonged ileus occurred in 10 percent of the electroacupuncture group and 20 percent of the sham group. There were no severe adverse events, and as in the new trial, most other secondary outcomes were unchanged.
A 2024 meta-analysis pooled 16 studies and 1,562 patients and reported larger benefits still, including about 10 fewer hours to first flatus, a lower risk of overall complications, and 1.22 fewer days in hospital [3].
The meta-analysis reached its 1.22-day figure largely by comparing electroacupuncture against standard care, where nobody is blinded and everyone knows who got the extra attention. Both of the sham-controlled trials, where the comparison is against a convincing imitation of the treatment, found no difference in length of stay [1,2]. When a benefit appears against standard care and disappears against sham, the most economical explanation is that part of it was the attention rather than the needles. The findings that held up against sham are the bowel-function timings, and those are the ones I would treat as established.
Nearly all of these trials were conducted in China, and the person performing acupuncture cannot be blinded to whether they are delivering the real thing.
What the mechanism findings suggest
Surgery on the abdomen produces an inflammatory response and shifts the autonomic nervous system toward sympathetic dominance, meaning the fight-or-flight side takes over, and gut motility depends largely on parasympathetic activity. A treatment that raises parasympathetic markers and lowers inflammatory cytokines while the bowel resumes working fits a coherent physiological explanation [1]. That is a more useful kind of evidence than an unexplained clinical benefit, seeing as it makes predictions that later trials can check.
This is where I have to be disciplined. My daily practice involves chronic motility problems: gastroparesis (a stomach that empties too slowly), constipation-predominant patterns, small intestinal bacterial overgrowth, the long unglamorous work of getting a gut moving again in someone who has been unwell for years. It is tempting to treat a postoperative ileus result as support for that work, and doing so would be a mistake. A healthy bowel temporarily stopped by surgery and a bowel that has moved too slowly for a decade are different problems, and the evidence for one does not transfer to the other. What I take from the surgical research is a mechanism to take seriously and a reason to keep asking the question, and I cannot claim more than that for chronic motility problems.
Asking about acupuncture in a surgical ward
Raise it before the operation. In these trials treatment began within hours of surgery [1,2]. If it is going to be part of the plan, that has to be arranged while the plan is still being made.
Ask specifically about electroacupuncture. The trials used electrical stimulation applied through the needles, which is not the same as standard manual acupuncture, and the evidence described here is for the electrical version.
Know which outcome you are hoping to change. The sham-controlled evidence supports faster return of bowel function. It does not support getting out of the hospital sooner [1,2].
Ask who would provide it. In these studies it was delivered by acupuncturists working inside the hospital as part of the surgical care, rather than by an outside practitioner.
Expect your team to want more than one trial. That is the correct response to evidence at this stage, and a surgeon who asks for replication is doing their job.
Enhanced Recovery After Surgery protocols already assemble a long list of small interventions, each reducing by a few hours the time it takes to return to normal function. This may end up being one of them. The two sham-controlled trials reached the same conclusion, which is more consistency than most complementary therapies have, and the question is still not settled.
References
Primary research located and verified via PubMed.
Li H, Cai Y, Wang Y, et al. Electroacupuncture for Postoperative Gastrointestinal Recovery After Laparoscopic Colorectal Cancer Resection: A Randomized Controlled Trial. Dis Colon Rectum. 2026 (published online August 6, 2026). PMID 42559736. https://doi.org/10.1097/DCR.0000000000004401 (digest source article; ChiCTR2100050660)
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 Surg. 2023;158(1):20-27. PMID 36322060. https://doi.org/10.1001/jamasurg.2022.5674
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. Int J Surg. 2024;110(2):1113-1125. PMID 37916930. https://doi.org/10.1097/JS9.0000000000000848
A note before you go
This article is educational and is not medical advice. It is not a recommendation for or against acupuncture in your own care, and it does not describe treatment for cancer. I am a licensed acupuncturist, which is a reason to read what I write on this subject with that in mind rather than a reason to take it as a recommendation. Decisions about what happens around an operation belong with the surgical team who will be looking after you, and the time to ask them is before the date arrives.
If this resonates with what you're experiencing and you'd like to explore a naturopathic approach, book a consultation with our clinic.
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