Study protocol evaluating the use of bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter randomized controlled trial

Garfinkle, Richard; Trabulsi, Nora; Morin, Nancy; Phang, Terry; Liberman, Sender; Feldman, Liane S.; Fried, Gerald M.; Boutros, Marylise

doi:10.1111/codi.13720

Cited by 20 publications

(18 citation statements)

References 20 publications

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“…We also identified a study protocol and a trial abstract for two ongoing RCTs for which no results were available. They were both registered in ClinicalTrials.gov (NCT02559635 and NCT02751736 ) and investigate preoperative bowel stimulation with saline and probiotics , respectively, in patients with a temporary ileostomy after LAR.…”

Section: Resultsmentioning

confidence: 99%

Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review

et al. 2019

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Aim Closure of a diverting ileostomy following restorative surgery is often associated with significant shortterm morbidity and variable long-term bowel function. The aim of this systematic review was to investigate if preoperative stimulation of the defunctioned bowel restores bowel function more quickly after ileostomy closure and improves postoperative outcomes when compared with standard preoperative care.Method MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov were searched for studies evaluating preoperative bowel stimulation in patients with a temporary ileostomy after low anterior resection or ileal pouch-anal anastomosis, regardless of their design, publication type or language. Study selection, data extraction and study assessment were performed by one reviewer and verified by another. Study results were synthesized narratively. The GRADE approach was used to assess the quality of evidence.Results Eight studies involving a total of 267 participants were included. The studies had a moderate to high risk of bias and were of varying methodological quality. Preoperative stimulation of the defunctioned bowel reduced the time to postoperative restoration of bowel function and the length of hospital stay when compared with standard preoperative care. Other functional outcomes and postoperative complication rates were similar to those of standard preoperative care. The overall quality of evidence was very low.Conclusion Despite these promising early results, there is insufficient high-quality evidence to recommend routine implementation of preoperative bowel stimulation in clinical practice. Nevertheless, there is no evidence suggesting that the intervention worsens outcomes or is unsafe, paving the way for rigorous assessment of effectiveness, acceptability and cost-effectiveness within the context of well-designed clinical trials.

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Section: Resultsmentioning

confidence: 99%

Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review

et al. 2019

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“…The postoperative nutrition was regulated; a liquid diet was commenced two hours after cesarean section and advanced to a regular diet within the four hours. Postoperative ileus was described as a narrow mindedness to oral nourishment without clinical or radiological indications of obstruction, that either a) requires nasogastric tube insertion; or b) was related with two of the accompanying: nausea/vomiting, stomach distension, and the nonattendance of flatus hours on or after postoperative day two [21].…”

Section: Methodsmentioning

confidence: 99%

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

et al. 2020

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Objectives: To evaluate whether coffee consumption accelerates the recovery of bowel function after cesarean section or not. Material and methods: This study was designed as randomized controlled study. Patients were randomly assigned to one of two groups: Ultimately, Group 1 (n = 51) was the study group and drank three cups of coffee after cesarean, whereas group 2 (n = 52) was not given any treatment. The primary outcome measure was the time to first defecation after surgery, the secondary outcomes were time to first bowel movement, passage of flatus, time to toleration of a solid diet, additional antiemetic and analgesic requirement. Results: There were no significant differences in demographic variables between the groups. The mean time to passage of first flatus was significantly shorter in the study group than the control group (8.6 ± 3.3 h vs 11.3 ± 7.5 h, respectively; p = 0.022). First defecation was 20.7 ± 11.5 h for the study group and at 29.1 ± 14.3 h for the control group (p = 0.001). In addition, there was a significant difference in mean time to toleration of solid food between the study and control groups (8.78 ± 2.33 h vs 12.88 ± 4.2.60 h, respectively; p < 0.001). Conclusions: Coffee can be used in patients to enhance the recovery of gastrointestinal function after elective cesarean section.

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“…Distal bowel and colon, which are unready to re-establish transit, cause intestinal paralysis. In this regard, several articles have been published [13][14][15][16][17], but the first systematic review was published by Rombey et al [9] in 2019, including eight studies with 267 patients. Despite the excellent initial results, there is not sufficient evidence to recommend the routine implementation of preoperative bowel stimulation in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

et al. 2021

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Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.

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Study protocol evaluating the use of bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter randomized controlled trial

Cited by 20 publications

References 20 publications

Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review

Preoperative bowel stimulation prior to ileostomy closure to restore bowel function more quickly and improve postoperative outcomes: a systematic review

Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial

Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

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