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Techniques in Coloproctology

, Volume 19, Issue 3, pp 165–172 | Cite as

Colonic transit in the empty colon after defunctioning ileostomy: Do we really know what happens?

  • J. M. AliEmail author
  • S. G. Rajaratnam
  • S. Upponi
  • N. R. Hall
  • N. S. Fearnhead
Original Article

Abstract

Background

There is disagreement amongst surgeons about the use of oral mechanical bowel preparation (MBP) prior to low anterior resection with diverting ileostomy. Colonic transit in the early post-operative period is an important factor in determining the role of MBP, as propagation of any stool remaining in the defunctioned colon may exacerbate morbidity in the event of anastomotic leak. We studied colonic transit time in the first 7 days following low anterior resection with diverting ileostomy.

Methods

We conducted a prospective observational study of patients with rectal cancer undergoing elective low anterior resection with diverting ileostomy in a tertiary colorectal unit. Twenty radio-opaque markers were inserted into the caecum via the distal limb of the loop ileostomy at surgery. Plain abdominal radiographs were taken on post-operative days 1, 3 and 5. The primary endpoint was passage of the markers to the neorectum. Data were collected on treatment, return of gastrointestinal function and complications.

Results

Twenty-two patients (mean age 68.5 years; 18 males) participated in the study. In 20 patients, all markers remained in the right colon on day 7. Three markers were present in the left colon in one patient, and eight markers were present in the neorectum in another patient, on the seventh day.

Conclusions

Colonic transit may be abolished by the presence of diverting ileostomy. It should now be established whether clearance of the left colon alone, using enemas, is sufficient for patients undergoing low anterior resection, thus avoiding the morbidity associated with oral MBP.

Keywords

Colonic motility Mechanical bowel preparation Diverting loop ileostomy 

Notes

Acknowledgments

The authors would like to acknowledge Dr Elizabeth Wlodek and Mr Nikolaos Chatzizacharias who assisted in patient recruitment and data collection. They would also like to thank Mr Richard Miller, Mr Justin Davies, Mr Michael Powar and Mr Andrew Clark who supported the study through patient recruitment and carrying out the study intervention. The additional plain radiographs required for this study were funded by a grant from the Addenbrooke’s Charitable Trust. The cost of the markers used was borne by the Cambridge Colorectal Research Fund.

Conflict of interest

None.

References

  1. 1.
    Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H, Working Group’ Colon/Rectum Carcinoma’ (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142CrossRefPubMedGoogle Scholar
  2. 2.
    Huser N, Michalski CW, Erkan M et al (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60CrossRefPubMedGoogle Scholar
  3. 3.
    Eskicioglu C, Forbes SS, Fenech DS, McLeod RS, Best Practice in General Surgery C (2010) Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg 53:385–395PubMedCentralPubMedGoogle Scholar
  4. 4.
    Bretagnol F, Panis Y, Rullier E et al (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868CrossRefPubMedGoogle Scholar
  5. 5.
    Van’t Sant HP, Weidema WF, Hop WC, Oostvogel HJ, Contant CM (2010) The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg 251:59–63CrossRefPubMedGoogle Scholar
  6. 6.
    Nicholson GA, Finlay IG, Diament RH, Molloy RG, Horgan PG, Morrison DS (2011) Mechanical bowel preparation does not influence outcomes following colonic cancer resection. Br J Surg 98:866–871CrossRefPubMedGoogle Scholar
  7. 7.
    Guenaga KF, Matos D, Wille-Jorgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev CD001544Google Scholar
  8. 8.
    Gravante G, Caruso R, Andreani SM, Giordano P (2008) Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5000 patients. Int J Colorectal Dis 23:1145–1150CrossRefPubMedGoogle Scholar
  9. 9.
    Cao F, Li J, Li F (2012) Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 27:803–810CrossRefPubMedGoogle Scholar
  10. 10.
    Augestad KM, Lindsetmo RO, Reynolds H et al (2011) International trends in surgical treatment of rectal cancer. Am J Surg 201:353–357CrossRefPubMedGoogle Scholar
  11. 11.
    Andersen J, Thorup J, Wille-Jorgensen P (2011) Use of preoperative bowel preparation in elective colorectal surgery in Denmark remains high. Dan Med Bull 58:A4313PubMedGoogle Scholar
  12. 12.
    Sasaki J, Matsumoto S, Kan H et al (2012) Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation. J Nippon Med Sch 79:259–266CrossRefPubMedGoogle Scholar
  13. 13.
    Villarreal J, Sood M, Zangen T et al (2001) Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions. J Pediatr Gastroenterol Nutr 33:588–591CrossRefPubMedGoogle Scholar
  14. 14.
    Hallgren T, Oresland T, Cantor P, Fasth S, Hulten L (1995) Intestinal intraluminal continuity is a prerequisite for the distal bowel motility response to feeding. Scand J Gastroenterol 30:554–561CrossRefPubMedGoogle Scholar
  15. 15.
    Freise H, Fischer LG (2009) Intestinal effects of thoracic epidural anesthesia. Curr Opin Anaesthesiol 22:644–648CrossRefPubMedGoogle Scholar
  16. 16.
    van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218CrossRefPubMedGoogle Scholar
  17. 17.
    Bassotti G, de Roberto G, Castellani D, Sediari L, Morelli A (2005) Normal aspects of colorectal motility and abnormalities in slow transit constipation. World J Gastroenterol 11:2691–2696CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Theophilus MHS, Cui J, Bell S, Warrier S (2014) Colonic motility is abolished following diverting loop ileostomy (abstr.). Colorectal Dis 16(Supplement 2):22Google Scholar
  19. 19.
    Evans RC, Kamm MA, Hinton JM, Lennard-Jones JE (1992) The normal range and a simple diagram for recording whole gut transit time. Int J Colorectal Dis 7:15–17CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2015

Authors and Affiliations

  • J. M. Ali
    • 1
    Email author
  • S. G. Rajaratnam
    • 1
  • S. Upponi
    • 2
  • N. R. Hall
    • 1
  • N. S. Fearnhead
    • 1
  1. 1.Cambridge Colorectal Unit, Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
  2. 2.Department of Radiology, Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK

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