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Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study

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Abstract

Background

The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer.

Methods

Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus.

Results

A total of 58 patients were included [42 males and 16 females, median age 67 (43–85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups.

POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01–0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI.

Conclusions

PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.

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Funding

No funding or grant was received for the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain

    J. Ocaña, J. C. García-Pérez, G. Rodríguez-Velasco, I. Moreno, A. Ballestero, P. Abadía, J. M. Fernández-Cebrián & J. Die

  2. Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain

    M. Labalde-Martínez, A. Vivas & E. Ferrero

  3. Stomatherapist at Ramon Y Cajal University Hospital, Madrid, Spain

    I. Clemente-Esteban

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  1. J. Ocaña
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Correspondence to J. Ocaña.

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Ethical approval

All procedures performed in this study are in accordance with the ethical standards of the institutional research committee (213-28) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtain from each patient included in this study.

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Ocaña, J., García-Pérez, J.C., Labalde-Martínez, M. et al. Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study. Tech Coloproctol 26, 645–653 (2022). https://doi.org/10.1007/s10151-022-02620-1

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