The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch

Maeda, Koutarou; Hashimoto, Mitsumasa; Koh, Junichi; Yamamoto, Osami; Hosoda, Youichirou; Morikawa, Yasuhide

doi:10.1007/bf00311445

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…39 The aims of this technique were to predict postclosure complications, using a simple reversible device and to reduce the frequency of defecation after closure. A custom-designed connector was inserted in a single patient, 12 weeks after ileostomy formation, until closure 3 months later.…”

Section: Discussionmentioning

confidence: 99%

The effect of faecal diversion on human ileum

Williams

Armstrong²,

Finan³

et al. 2007

Gut

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Background: The use of a loop ileostomy is an effective method in protecting pelvic anastomoses. Its use has increased recently, although there is some debate as to the routine use of a stoma. Reversal of the ileostomy is associated with a significant morbidity, which may be related to impaired function of the bypassed distal limb of the ileum. Aim: To investigate the changes that might occur in the distal limb after an interval of faecal diversion. Methods: Full-thickness intestinal circular muscle (CM) strips were prepared from excised loop ileostomies taken at the time of closure. The study sample was from the distal limb and the control from the proximal limb. Contractile activity was measured using an organ bath set up to record isometric contraction after stimulation by acetylcholine (ACh). Histological sections were assessed for an index of villous atrophy, smooth muscle area, and nerve and vessel density. Analysis was with the Wilcoxon signed ranks test for paired data and the Mann-Whitney U test for unpaired data. Results: Samples were acquired prospectively from 35 consecutive patients. The median time between formation and closure of ileostomy was 34 weeks. Significant reduction was observed in the strength of CM contraction, smooth muscle area and median villous index of the distal limb compared with the proximal limb. Conclusion: Impaired intestinal function has been proposed as a contributory factor in the morbidity that may follow closure of loop ileostomy. Significant loss of contractility and smooth muscle strength and villous atrophy occur in the distal ileal limb after faecal diversion. Methods of preventing these changes should be considered.

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Section: Discussionmentioning

confidence: 99%

The effect of faecal diversion on human ileum

Williams

Armstrong²,

Finan³

et al. 2007

Gut

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“…In contrast, two comparative studies did not observe a difference between the intervention and the control group 5 days [42] or 7 days postoperatively [43]. In the case report of a patient with an ileoanal pouch who underwent bowel stimulation with an ileostomy connector [40], the daily frequency of stools within the first 24 h after ileostomy closure was 6.5 times and therefore slightly less than in the comparative studies. Two case reports reported results regarding the onset of intestinal peristalsis [37,41], which were similar.…”

Section: Other Functional Outcomesmentioning

confidence: 85%

“…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.…”

Section: Search and Study Selectionmentioning

confidence: 99%

“…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.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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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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“…GI side effects were reported in association with CR in some studies, including abdominal discomfort, diarrhea, constipation, nausea, and vomiting, which were generally controlled sufficiently to enable reinfusion to be continued. 10,20,23,29,36,41,42 However, it was not clear whether these effects were directly related to CR or the underlying etiology that resulted in DES or EAF formation, or both. One article noted that extremely rapid or bolus reinfusion may contribute to these symptoms.…”

Section: Adverse Events and Mortalitymentioning

confidence: 99%

Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

et al. 2019

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Background High‐output double enterostomies (DESs) and enteroatmospheric fistulas (EAFs) of the small bowel account for substantial patient morbidity and mortality. Management may include parenteral nutrition (PN) and prolonged admissions, at high cost. Reinfusion of chyme into the distal bowel is a proposed therapeutic alternative when the distal DES limb is accessible; however, standardized information on this technique is required. This review aimed to critically assess the literature regarding chyme reinfusion (CR) to define its current status and future directions. Methods A systematic search of medical databases was conducted for articles investigating CR in adults. Articles reporting indications, methods, benefits, technical issues, and complications resulting from CR were reviewed. A narrative synthesis of the retrieved data was undertaken. Results In total, 24 articles reporting 481 cases of CR were identified, although articles were heterogeneous in their structure and reporting. CR was most frequently performed for remediation of high‐output DES and intestinal failure and for proximally located DES. Effluent output collection was commonly manual, with distal reinfusion more commonly automated, and with few dedicated systems. Multiple benefits attributed to CR were reported, encompassing weight gain, cessation of PN, and improvements in liver function. Technical problems included distaste, labor‐intensive methods, reflux of contents, and tube dislodgement. No serious AEs or mortality directly attributable to CR were reported. Conclusions CR appears to be a promising, safe and well‐validated intervention for small bowel DES and EAF. However, more efficient and acceptable methods are required to promote greater adoption of the practice of CR.

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The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch

Cited by 6 publications

References 24 publications

The effect of faecal diversion on human ileum

The effect of faecal diversion on human ileum

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

Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

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