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

Autor: Garfinkle R; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Demian M; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Sabboobeh S; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Moon J; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Hulme-Moir M; Department of Surgery, North Shore Hospital, Auckland, New Zealand., Liberman AS; Department of Surgery, McGill University Health Center, Montreal, Canada., Feinberg S; Department of Surgery, North York General Hospital, Toronto, Canada., Hayden DM; Division of Colon and Rectal Surgery, Rush University Medical Center, Chicago, USA., Chadi SA; Department of Surgery, University Health Network, Toronto, Canada., Demyttenaere S; Department of Surgery, St. Mary's Hospital, Montreal, Canada., Samuel L; Department of Nursing, Jewish General Hospital, Montreal, Canada., Hotakorzian N; Department of Nursing, Jewish General Hospital, Montreal, Canada., Quintin L; Department of Nursing, Jewish General Hospital, Montreal, Canada., Morin N; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Faria J; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Ghitulescu G; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Vasilevsky CA; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Boutros M; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada. marylise.boutros@mcgill.ca.; Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada. marylise.boutros@mcgill.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 May; Vol. 37 (5), pp. 3934-3943. Date of Electronic Publication: 2022 Aug 19.
DOI: 10.1007/s00464-022-09510-5
Abstrakt: Introduction: The objective of this study was to evaluate the impact of preoperative bowel stimulation on the development of postoperative ileus (POI) after loop ileostomy closure.
Methods: This was a multicenter, randomized controlled trial (NCT025596350) including adult (≥ 18 years old) patients who underwent elective loop ileostomy closure at 7 participating hospitals. Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group). Bowel stimulation consisted of 10 outpatient sessions within the 3 weeks prior to ileostomy closure and was performed by trained Enterostomal Therapy nurses. The primary outcome was POI, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, on or after postoperative day 3, that either (a) required nasogastric tube insertion; or (b) was associated with two of the following: nausea/vomiting, abdominal distension, or the absence of flatus.
Results: Between January 2017 and November 2020, 101 patients were randomized, and 5 patients never underwent ileostomy closure; thus, 96 patients (47 stimulated vs. 49 control) were analyzed according to a modified intention-to-treat protocol. Baseline characteristics were well balanced in both groups. The incidence of POI was lower among patients randomized to stimulation (6.4% vs. 24.5%, p = 0.034; unadjusted RR: 0.26, 95% CI 0.078-0.87). Stimulated patients also had earlier median time to first flatus (2.0 days (1.0-2.0) vs. 2.0 days (2.0-3.0), p = 0.025), were more likely to pass flatus on postoperative day 1 (46.8% vs. 22.4%, p = 0.022), and had a shorter median postoperative hospital stay (3.0 days (2.0-3.5) vs. 4.0 days (2.0-6.0), p = 0.003).
Conclusions: Preoperative bowel stimulation via the efferent limb of the ileostomy reduced POI after elective loop ileostomy closure.
(© 2022. The Author(s).)
Databáze: MEDLINE
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