Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Rodríguez-Padilla, Ángela; Morales-Martín, Germán; Pérez-Quintero, Rocío; Gómez‐Salgado, Juan; Balongo-García, Rafael; Ruiz‐Frutos, Carlos

doi:10.3390/nu13020626

Cited by 15 publications

(24 citation statements)

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“…The observations presented here demonstrate that the decrease in endoscopic and histological findings associated with the decrease in inflammation means that stimulation of the efferent loop of the ileostomy with probiotics can be an alternative treatment in patients with symptomatic DC who are not candidates for reconstructive surgery as a treatment to resolve the colonic inflammation (29,30). Finally, the stimulation of the efferent loop with probiotics can be an alternative treatment to resolve the inflammation in patients whose surgical option is not feasible.…”

Section: Discussionmentioning

confidence: 73%

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

et al. 2021

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Background: Diversion colitis is a non-specific inflammation of a defunctionalised segment of the colon after a temporary stoma has been performed. This inflammation is associated with a change in the colonic flora.Aim: To evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to closure of the protective ileostomy in patients operated on colorectal carcinoma and its effect on diversion colitis. A prospective, randomised, double-blind, controlled study is carried out.Methods: Patients who underwent surgery for colorectal carcinoma with protective ileostomy pending reconstructive surgery and with diversion colitis as diagnosis are included. Randomised and divided into two groups. Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery.Results: Patients in CG were distributed according to the endoscopic index of severity in pre-stimulation/post-stimulation as follows: severe n = 9/9 (25.7%), moderate n = 23/23 (65.7%), and mild n = 3/3 (8.6%); compared to the distribution in SG, severe n = 9/0 (26.5/0%), moderate n = 23/3 (67.6/8.8%), mild n = 2/19 (5.9/55.9%) and normal colonoscopy in 0/12 patients (0/35.3%).Conclusion: Probiotic stimulation of the efferent loop is a safe and effective method, managing to reduce both macroscopic and microscopic colitis, as well as a decrease in symptoms in the short term after reconstructive surgery.

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Section: Discussionmentioning

confidence: 73%

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

et al. 2021

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“…The main treatment for colitis is the restoration of the continuity of the digestive tract, including ileostomy reversal or stimulation of the efferent loop with probiotics prior to surgery (21). Several studies have shown that probiotics or nutrient solution stimulation 1-2 weeks prior to surgery could improve bowel function after ileostomy closure, which further confirm the reversibility of colitis (11)(12)(13)21). Similarly, in this study, we found that colitis was not a risk factor for frequent defecation 1 month after ileostomy closure.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications are postoperative ileus and frequent defecation (10). Several studies have shown that stimulation with probiotics before ileostomy closure could reduce the rate of postoperative ileus (11)(12)(13)(14). Previous study showed that a nomogram can be established to predict long-term complications after patients receiving anterior resection (15).…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict risk factors of frequent defecation early after ileostomy reversal for rectal cancer patients

Deng

et al. 2021

Ann Transl Med

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Background: Defecation disorders after ileostomy reversal are among the most common complications for rectal cancer patients, and significantly diminish their quality of life. The aim of this study was to identify the risk factors associated with frequent defecation early after ileostomy reversal for rectal cancer patients.Methods: We retrospectively collected the data of rectal cancer patients who underwent ileostomy reversal from January 2018 to December 2019 at the Sixth Affiliated Hospital of Sun Yat-sen University. We divided patients into two groups: a no frequent defecation group (≤7 times/day) and a frequent defecation group (>7 times/day).Results: Of the 264 included patients, 59 patients (22.35%) had frequent defecation within 1 month after ileostomy closure and were defined as the frequent defecation group. There were no significant differences between the two groups in terms of gender, age, hypertension, and diabetes. Univariate and multivariate analyses showed that proctitis (P=0.04) and anastomotic stenosis (P=0.02) were independent risk factors for frequent defecation. Four factors, including proctitis, anastomotic stenosis, hypertension, and age were included to construct the nomogram. The consistency index of the nomogram was 0.949 and the area under the curve value was 0.623.Conclusions: For rectal cancer patients, proctitis and anastomotic stenosis were correlated with frequent defecation within 1 month after ileostomy closure. Surgeons should pay attention to the rectal examination before ileostomy reversal surgery.

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“…Rodríguez-Padilla et al [ 16 ], in a recently published randomized clinical trial, evaluated 69 patients. The intervention group had the efferent ileostomy loop stimulated with probiotics (Vivomixx®).…”

Section: Introductionmentioning

confidence: 99%

Rectal stimulation with prebiotics and probiotics before ileostomy reversal: a study protocol for a randomized controlled trial

Marcelino

Tustumi

Gerbasi

et al. 2023

Trials

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Background Ileostomy closure is associated with a high rate of postoperative morbidity, and adynamic ileus is the most common complication, with an incidence of up to 32%. This complication is associated with delayed initiation of oral diet intake, abdominal distention, prolonged hospital stay, and more significant patient discomfort. The present study aims to evaluate the rectal stimulus with prebiotics and probiotics before ileostomy reversal. Methods This is a protocol study for an open-label randomized controlled clinical trial. Ethical approval was received (CAAE: 56551722.6.0000.0071). The following criteria will be used for inclusion: adult patients with rectal cancer stages cT3/4Nx or cTxN+ that underwent loop protection ileostomy, patients treated with neoadjuvant chemoradiotherapy, and patients who underwent laparoscopic or robotic total mesorectal excision. Patients will be randomized to one of two groups. The intervention group (with rectal stimulus): the patients will apply 500 ml of saline solution with 6 g of Simbioflora® rectally, once a day, for 15 days before ileostomy closure. The control group (without rectal stimulation): the patients will close the ileostomy with no previous rectal stimulus. The primary outcomes will be the adynamic ileus (need for postoperative nasogastric tube insertion; nausea/vomiting; or intolerance to oral feedings within the first 72 h) and intestinal transit (time to first evacuation/flatus). Results The patient’s enrollment starts in January 2023. We expect to finish in July 2025. Discussion The findings of this randomized clinical study may have important implications for managing patients undergoing ileostomy reversal. Trial registration This study is registered in the Brazilian Trial Registry (ReBEC) under RBR-366n64w. Registration date: 19/07/2022

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Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Cited by 15 publications

References 24 publications

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

A nomogram to predict risk factors of frequent defecation early after ileostomy reversal for rectal cancer patients

Rectal stimulation with prebiotics and probiotics before ileostomy reversal: a study protocol for a randomized controlled trial

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