Postoperative ileus is an undesirable stress response to major abdominal surgery that can cause abdominal pain, postoperative nausea and vomiting, distention, delayed passage of stool and the inability to take in sufficient fluids and solids. In this Review, the author considers the techniques currently available to prevent or reduce the duration of postoperative ileus, including the concept of multimodal postoperative rehabilitation (fast-track surgery).