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

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Oncology

Background:

• Low anterior resection for rectal cancer often necessitates a temporary loop ileostomy.
• Postoperative ileus (POI) is a common complication following ileostomy closure.
• Effective strategies to mitigate POI are crucial for patient recovery.

Purpose of the Study:

• To evaluate the impact of preoperative physiological stimulation (PPS) on POI after ileostomy closure.
• To compare PPS with standard treatment (ST) in patients with loop ileostomy.
• To identify predictors of POI in this patient cohort.

Main Methods:

• Prospective study including 58 patients undergoing ileostomy closure.
• PPS involved daily self-instillation of fecal contents for 15 days prior to closure.
• Comparison between PPS group (n=24) and ST group (n=34).

Main Results:

• POI was significantly lower in the PPS group (4.2%) compared to the ST group (32.4%).
• The PPS group experienced faster restoration of bowel function (1 day vs. 3 days) and liquid tolerance (1 day vs. 2 days).
• Predictors of POI included age, open surgical approach, adjuvant capecitabine, and prior abdominal surgeries.

Conclusions:

• Preoperative physiological stimulation (PPS) is a feasible method for patients undergoing ileostomy closure.
• PPS may significantly reduce the incidence and severity of postoperative ileus.
• Further research can explore optimizing PPS protocols to enhance recovery.