OBJECTIVES: Regardless of the wide variation in estimated incidence rates for post-operative ileus (POI), it is widely understood that gastrointestinal complications represent the most common post-operative morbidity type. In addition to the patient burden, the extension of hospital stay caused by POI (estimated to be between 3.2 and 8 days) can have an enormous economic impact, making this an important area of research. The objective of this literature review was to explore the various interventions investigated for the acceleration of gastrointestinal recovery after surgery and reduction of POI. METHODS: Comprehensive literature searches across online databases and horizon scanning were used to identify relevant literature. Literature was gathered on any intervention that had been assessed in a randomised clinical trial for the treatment of POI following abdominal surgery. RESULTS: Over 600 studies were identified as potentially relevant. Approximately one quarter of these assessed the broad spectrum of prokinetic pharmacological agents for the treatment of POI, as well as antiemetics, antibiotics and anaesthetics. In particular, research into new ghrelin agonists is underway. Next to this, the unfavourable effects of opioid analgesics on GI recovery were studied in numerous trials. Non-pharmacological methods to enhance recovery after surgery such as gum chewing, acupuncture and early feeding have also been investigated with mixed success. Many of the trials identified were dated, illustrating how long POI has remained an unresolved issue for clinicians and patients. CONCLUSIONS: Many different types of treatment, with varying mechanisms of action, have been clinically studied for the prevention or treatment of POI over the past 40 years. However, there is still no standard management paradigm to accelerate post-operative bowel recovery. The absence of an effective pharmacological agent licensed for this indication in Europe and significant variance in practice suggest an unmet clinical need, which should shape future research in this area.