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Colonic transit in the empty colon after defunctioning ileostomy: do we really know what happens?
J M Ali1, S G Rajaratnam, S Upponi
1Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, BOX 201, Hills Road, Cambridge, CB2 0QQ, UK, ja297@cam.ac.uk.
Techniques in Coloproctology
|February 21, 2015
Summary
A diverting ileostomy may halt colonic transit after low anterior resection surgery. Further research is needed to determine if enemas alone suffice, potentially avoiding oral mechanical bowel preparation risks.
Area of Science:
- Colorectal Surgery
- Gastrointestinal Physiology
Background:
- Surgeons debate the necessity of oral mechanical bowel preparation (MBP) before low anterior resection with diverting ileostomy.
- Early postoperative colonic transit influences MBP's role, as stool can worsen anastomotic leak complications.
- This study investigated colonic transit in the first 7 days post-low anterior resection with diverting ileostomy.
Purpose of the Study:
- To assess colonic transit time in patients undergoing low anterior resection with a diverting ileostomy.
- To evaluate the impact of a diverting ileostomy on colonic transit.
- To inform decisions regarding the use of oral mechanical bowel preparation.
Main Methods:
- Prospective observational study in a tertiary colorectal unit.
- Radio-opaque markers inserted into the cecum via ileostomy at surgery.
- Abdominal radiographs taken on postoperative days 1, 3, and 5 to track marker passage.
Main Results:
- Twenty-two patients (mean age 68.5 years) were studied.
- In 20 patients, all markers remained in the right colon by day 7.
- One patient had markers in the left colon, and another had markers in the neorectum by day 7.
Conclusions:
- Diverting ileostomy appears to abolish colonic transit.
- Further investigation is required to determine if left colon clearance with enemas is adequate.
- This could help avoid complications associated with oral mechanical bowel preparation.
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