Postoperative ileus (POI) is an inevitable adverse consequence of abdominal and other surgical procedures. Prolonged POI can lead to slow postoperative recovery, add to the patients discomfort and ultimately prolonged hospitalization and increased costs. It is believed that POI occurs as a result of inhibitory neural reflexes and inflammatory processes. The potential influence of endogenous opioids, in addition to exogenous opioids on the pathogenesis of POI has become more evident. The traditional routine use of nasogastric suction and the effects of prokinetic agents has been studied more and either challenged or refuted. Current treatment modalities, which are well studied includes the use of epidural long-acting local anaesthetics, early enteral feeding, multimodal postoperative care pathway, and less invasive surgical procedures. Recent research showed the usefulness of the newly introduced medications among the most promising is the peripherally acting �-opioid antagonist.