Background: Delayed return of bowel function after open colorectal surgery contributes to postoperative ileus (POI), prolonged hospital stays, and increased healthcare costs. While warm humidified CO₂ insufflation (WHCI) benefits laparoscopic surgery, its role in open procedures remains unclear. Methods: A systematic review and meta-analysis of RCTs comparing WHCI with standard care in open abdominal surgery was conducted (databases: PubMed, OVID, Cochrane, Google Scholar; until Jan 2025). Outcomes included time to first flatus, stool passage, and incidence of POI. Results: Nine RCTs met inclusion criteria (modest sample sizes, methodological variability). WHCI significantly reduced time to first flatus (2.5 vs 5.0 days, p = 0.008), trended towards earlier stool passage (3.7 vs 5.5 days, p = 0.092), and showed fewer POI cases (OR 0.26, p = 0.074). Future Directions: We have launched the first large-scale, multicentre RCT (ACTRN12625000087459) powered to evaluate WHCI’s effect on bowel recovery after open colorectal resection using the HumiGard system. The primary outcome is time to return of bowel function (flatus or stool by 24, 48, and 72 hours). Conclusion: Early data suggest WHCI may expedite bowel function recovery in open abdominal surgery. A definitive RCT will be underway, with potential implications for ERAS protocols and surgical recovery pathways to reduce costs.