Enteral resorbable diet versus standard diet in primary sphincter reconstruction: a prospective randomised trial.

Autor: Joos A; Deutsches End- und Dickdarm-Zentrum, Mannheim, Germany., Bussen D; Deutsches End- und Dickdarm-Zentrum, Mannheim, Germany., Galata C; Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany., Reißfelder C; Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany., Herold A; Deutsches End- und Dickdarm-Zentrum, Mannheim, Germany., Seyfried S; Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. steffen.seyfried@umm.de.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2021 Jul; Vol. 36 (7), pp. 1455-1460. Date of Electronic Publication: 2021 Mar 23.
DOI: 10.1007/s00384-021-03878-x
Abstrakt: Aim: Bowel movements after reconstructive anorectal surgery may negatively affect surgical outcome. This study was aimed to assess any differences between a standard diet (SD) and the enteral resorbable diet (ED) in terms of operative outcomes and patient tolerance after fistulectomy with primary sphincter reconstruction.
Method: Adult patients undergoing elective fistulectomy with primary sphincter reconstruction for anorectal and rectovaginal fistulas were eligible for inclusion. Patients were intraoperatively randomised to receive either the ED and peristalsis-inhibiting medication (ED) or a SD. The primary endpoint was the healing rate. Secondary endpoints included continence scores, complications and quality of life. Sample size calculation resulted in the analysis of 60 patients to detect a difference in fistula recurrence of 30% with 70% power and a 5% significance level.
Results: Sixty-six patients (24 women) were prospectively and randomly assigned to the ED (n = 34: 51%) or a SD (n = 32; 48%); mean age was 47 (18-74) years. The primary healing rate was 64 out of 66 patients (96%). No statistical difference in healing rate was seen between the groups. However, patient satisfaction was significantly higher in the SD group (P < 0.0001).
Conclusions: Fistulectomy with primary sphincter reconstruction is a safe method with low complication rates. Postoperative stool behaviour has no significant influence on the healing rate but has a significant negative impact on patient satisfaction. Therefore, maintaining a standard diet seems to be preferable following reconstructive anal surgery.
Trial Registration: The trial was registered with the German Clinical Trials Register ( DRKS00020524 ).
Databáze: MEDLINE
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