Stimulation of the Efferent Limb Before Ileostomy Closure

Abstract

Stimulation of the efferent limb of the ileostomy before closure is a safe technique that reduces postoperative ileus and fosters early intestinal transit and oral tolerance with a shorter postoperative hospital stay.

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

“…1). We included seven published studies from three bibliographic databases [37][38][39][40][41][42][43] and an ongoing study identified from ClinicalTrials.gov [44], for which the corresponding author provided results of an interim analysis that had been presented at the 22nd National Meeting of the Spanish Association Foundation of Coloproctology in Bilbao, Spain on 9 May 2018.…”

“…Of the eight included studies, five were comparative studies, with two RCTs [38,43] and three NRS [39,42,44], and three were case reports [37,40,41]. Two studies were registered in Clin-icalTrials.gov (NCT01881594 [38] and NCT03424447 [44]). Information on the funding source was available for two studies [39,44], and on ethics approval for all comparative studies [38,[42][43][44] except one [39].…”

“…The number of included patients ranged from one (in the three case reports) to 100. In four studies the included patients had a temporary ileostomy after IPAA [39,40,42,43], and in four studies after LAR [37,38,41,44]. Mean patient age ranged from 26 to 65 years, which can be explained by the different age of onset of the diseases.…”

“…In five studies, preoperative bowel stimulation was performed once daily with physiological saline [37,38,41,43,44]. In one study saline was used [43] in combination with a thickening agent.…”

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

“…Our current overall rate of POI following ileostomy closure at the institutions included in the study is 16%. Based on the previously published study and our clinical experience , we estimate an absolute risk reduction in POI of 13%. With an alpha of 0.05, and accounting for 5% loss to follow‐up, we calculate that a total sample size of 166 patients – 83 patients in each arm – would provide us with 80% power to detect a 13% risk reduction in POI.…”