Laparoscopy is a minimally invasive technique with the characteristics of easy operation, a small incision, rapid healing and satisfactory efficacy. It has been widely applied to the treatment of gynecological diseases (1). Physiologically, gastrointestinal motility results from muscularis mucosa contraction, segmentation and peristalsis (rhythmic contractions) (2). The rapid recovery of gastrointestinal motility often predicts satisfactory clinical outcomes following laparoscopies, and various rehabilitation interventions have been employed to prompt and restore gastrointestinal motility post-surgery (3).

Immediate anal exhaust following gynecological laparoscopies (GLs) is almost impossible due to the absence of intestinal smooth muscle contraction. Rhythmic motion slowly occurs at 3 to 8 h post-surgery, beginning from the proximal small intestine to the rectum and colon. Post-operative exhaust often represents the recovery of gastrointestinal transit (4). However, the post-operative anal evacuation time may vary among individuals; it is usually between 24-56 h in patients receiving GLs without other specific treatments, with an average of 31 h (5). However, in >80% of this patient group, the recovery gastrointestinal transit is delayed when they develop symptoms, such as abdominal distension, and decreases in peristalsis, anal exhaust and bowel episodes (6), though their peristalsis recovery time is shorter than that of patients undergoing conventional laparotomy (7,8).

The gastrointestinal tract is more sensitive to surgical stress than other parts of the body, the recovery of which can be disrupted or even impaired by surgical trauma, post-operative pain, anesthetics and analgesics, carbon dioxide pneumoperitoneum and other factors (9), leading to severe gastrointestinal motility disorders in some patients (10,11). Specifically, surgical trauma may cause post-operative gastrointestinal dysfunction. The study conducted by Magrina demonstrated that mortality rates following injury to the bowel during laparoscopic procedures ranged from 2.5 to 5% (12). Post-operative pain leads to the transient dysfunction of the enteric nervous system, inhibiting gastrointestinal transit by the binding of abundant norepinephrine released from sympathetic postganglionic neurons to receptors on smooth muscle cells (13,14) and can also lead to intestinal paralysis (15). As regards anesthetics and analgesics, opioids are the most effective and commonly used analgesics peri-operatively; however, they can induce delayed gastric emptying and intestinal transit, resulting in fluid and electrolyte disruption. The intraoperative use of anesthetics and analgesics may also inhibit the recovery of post-operative gastrointestinal motility. Carbon dioxide pneumoperitoneum has been widely utilized in laparoscopies to create operating and viewing space (16). However, carbon dioxide insufflation into the abdomen has also been reported to disrupt tissue or organ functions, such as breathing (17), digestive (18) and urinary functions (19). Following GL procedures, a small amount of carbon dioxide can pass through the peritoneum, and can be absorbed into the circulation and converted into carbonic acid, causing hypercapnia; this triggers the release of catecholamines to activate cholinergic neurons in the enteric nervous system (20) to induce gastrointestinal symptoms, such as nausea and vomiting (21).

The delayed recovery of gastrointestinal motility can significantly increase challenges in post-operative recovery and can aggravate patients' discomfort (22-25). This can occur in addition to another risk factor, intestinal dilation, that impairs wound healing and induces intestinal paralysis, nausea and vomiting, or severe complications such as arrhythmia and multiple organ dysfunction syndrome (26,27). Both of these conditions may impair the effectiveness of nursing care or rehabilitation, leading to longer hospital stays and higher medical expenditures.

A consensus on the management of gastrointestinal motility disorders post-GLs has not yet been reached, and the efficacy of relevant interventions reported to date is unsatisfactory (28). In the majority of cases, commonly prescribed drugs against these symptoms only achieve limited results, alongside pronounced adverse events (29) and extra costs, which limit their application in patients undergoing GLs (30). Traditional Chinese medicine (TCM) has been shown to exert preventive and therapeutic effects on post-operative gastrointestinal motility disorders. However, the efficacy of TCM is accumulative; treatment based on syndrome differentiation and acupuncture with needle manipulation are highly demanding tasks for novices, and moxibustion may cause burns (31,32). Therefore, non-drug treatments that are easy to use, cost-effective, non-invasive and highly repeatable for distinct operators are required to promote gastrointestinal motility recovery following GLs and to improve the quality of life of patients, promote early post-operative recovery and enhance the quality of nursing care (33).

Low-frequency electrical stimulation (LFES) is a suitable non-invasive technique that delivers low-frequency pulsed currents to the muscles and nerves through skin surface electrodes (34). The device is a portable apparatus and easy to operate for novices (Fig. 1). It is placed on acupoints, in a manner similar to acupuncture, but is not inserted into the skin. Thus, LFES can also exert a therapeutic effect similar to that of acupuncture, but circumvents adverse events, such as subcutaneous hematoma, accidental needle-sticks and fainting during acupuncture treatment (35); it is therefore more acceptable for patients. This treatment has been utilized in departments of obstetrics and gynecology, cardiovascular diseases, rehabilitation, TCM and surgery (36).

LFES promotes gastrointestinal motility post-GLs probably through elevating plasma ghrelin and motilin and parasympathetic activity. It is a non-invasive and non-pharmacological intervention recommended for early nursing care or rehabilitation post-surgery. Nonetheless, future clinical studies on adults, particularly placebo-controlled studies, are required to validate its efficacy and safety. A database for electrophysiological properties in patients undergoing LFES treatment is conducive to offering sufficient data for bioinformatics or clinical studies and establishing guidelines of LFES for the management of gynecological diseases.