Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded,...

Area of Science:

• Surgical Gastroenterology
• Clinical Trials
• Patient Recovery

Background:

• Postoperative ileus (POI) is a common complication following abdominal surgery, particularly after loop ileostomy closure.
• Current management strategies for POI are often reactive, focusing on treatment after onset rather than prevention.
• The need for effective preventative measures to improve patient outcomes and reduce healthcare costs is critical.

Purpose of the Study:

• To investigate the efficacy of preoperative bowel stimulation in mitigating the incidence of postoperative ileus (POI).
• To assess the impact of this intervention on key recovery parameters, including time to first flatus and hospital length of stay.
• To evaluate the safety and feasibility of a structured preoperative bowel stimulation protocol.

Main Methods:

• A multicenter, randomized controlled trial (NCT025596350) involving adult patients undergoing elective loop ileostomy closure.
• Participants were randomized to receive either 10 outpatient bowel stimulation sessions within 3 weeks prior to surgery or a control group (no stimulation).
• Postoperative ileus was defined by intolerance to oral intake requiring nasogastric tube insertion or associated symptoms; primary outcome assessed.

Main Results:

• The incidence of POI was significantly lower in the stimulated group (6.4%) compared to the control group (24.5%) (p=0.034).
• Patients receiving preoperative stimulation experienced an earlier median time to first flatus (2.0 days vs. 2.0 days, p=0.025) and were more likely to pass flatus on postoperative day 1.
• The median postoperative hospital stay was shorter for stimulated patients (3.0 days vs. 4.0 days, p=0.003).

Conclusions:

• Preoperative bowel stimulation is an effective strategy for reducing the incidence of postoperative ileus after elective loop ileostomy closure.
• This intervention accelerates gastrointestinal recovery, evidenced by earlier flatus passage and reduced hospital stay.
• The findings support the integration of preoperative bowel stimulation into clinical practice for patients undergoing ileostomy reversal.