Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial
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...
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| creator | Garfinkle, Richard Demian, Marie Sabboobeh, Sarah Moon, Jeongyoon Hulme-Moir, Michael Liberman, A. Sender Feinberg, Stan Hayden, Dana M. Chadi, Sami A. Demyttenaere, Sebastian Samuel, Louise Hotakorzian, Nevart Quintin, Laurence Morin, Nancy Faria, Julio Ghitulescu, Gabriela Vasilevsky, Carol-Ann Boutros, Marylise |
| description | 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. |
| doi_str_mv | 10.1007/s00464-022-09510-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9390101</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2808754809</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-d39346c27c9a1cd9e4c822605d1289c14318bebc91f89f343fc4531ec9b03b413</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhS0EosPAC7BAltiwaIr_MrFZIEEFLVIlNrC2HOdmcOXYwXaKyhvw1jhMaYEFK1s-3z2-Rwehp5ScUEK6l5kQsRMNYawhqqWkae-hDRWcNYxReR9tiOKkYZ0SR-hRzpek8oq2D9ERb5UULaMb9ONt_AYe5-KmxZviYsA9jDEB9jHO2HmIucTpGlsf81KfS8QJhsUCnldlhlSnrmAll_wKG1x9irMQCqRjnF3Ye2h678IAwzFOJgxxct9hwDaGkqL39VqSM_4xejAan-HJzblFn9-_-3R63lx8PPtw-uaisaITpRm44mJnWWeVoXZQIKxkbEfagTKpbI1PZQ-9VXSUauSCj1a0nIJVPeG9oHyLXh9856WfYFg3TcbrObnJpGsdjdN_K8F90ft4pRVXhJLV4MWNQYpfF8hFTy5b8N4EiEvWrCNCdpSqXUWf_4NexiWFGk8zSWTXClk72iJ2oGyKOScYb5ehRK9N60PTujatfzWt2zr07M8YtyO_q60APwC5SmEP6e7v_9j-BMIJt50</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2808754809</pqid></control><display><type>article</type><title>Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial</title><source>MEDLINE</source><source>SpringerLink (Online service)</source><creator>Garfinkle, Richard ; Demian, Marie ; Sabboobeh, Sarah ; Moon, Jeongyoon ; Hulme-Moir, Michael ; Liberman, A. Sender ; Feinberg, Stan ; Hayden, Dana M. ; Chadi, Sami A. ; Demyttenaere, Sebastian ; Samuel, Louise ; Hotakorzian, Nevart ; Quintin, Laurence ; Morin, Nancy ; Faria, Julio ; Ghitulescu, Gabriela ; Vasilevsky, Carol-Ann ; Boutros, Marylise</creator><creatorcontrib>Garfinkle, Richard ; Demian, Marie ; Sabboobeh, Sarah ; Moon, Jeongyoon ; Hulme-Moir, Michael ; Liberman, A. Sender ; Feinberg, Stan ; Hayden, Dana M. ; Chadi, Sami A. ; Demyttenaere, Sebastian ; Samuel, Louise ; Hotakorzian, Nevart ; Quintin, Laurence ; Morin, Nancy ; Faria, Julio ; Ghitulescu, Gabriela ; Vasilevsky, Carol-Ann ; Boutros, Marylise ; Bowel Stimulation Research Collaborative</creatorcontrib><description>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.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09510-5</identifier><identifier>PMID: 35984521</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2022 SAGES Oral ; Abdomen ; Abdominal Surgery ; Adolescent ; Adult ; Clinical trials ; Endoscopy ; Flatulence - complications ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Ileostomy - methods ; Ileus - epidemiology ; Ileus - etiology ; Ileus - prevention & control ; Intervention ; Intestines ; Length of stay ; Medicine ; Medicine & Public Health ; Ostomy ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Postoperative period ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2023-05, Vol.37 (5), p.3934-3943</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-d39346c27c9a1cd9e4c822605d1289c14318bebc91f89f343fc4531ec9b03b413</citedby><cites>FETCH-LOGICAL-c474t-d39346c27c9a1cd9e4c822605d1289c14318bebc91f89f343fc4531ec9b03b413</cites><orcidid>0000-0001-8006-321X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09510-5$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09510-5$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35984521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garfinkle, Richard</creatorcontrib><creatorcontrib>Demian, Marie</creatorcontrib><creatorcontrib>Sabboobeh, Sarah</creatorcontrib><creatorcontrib>Moon, Jeongyoon</creatorcontrib><creatorcontrib>Hulme-Moir, Michael</creatorcontrib><creatorcontrib>Liberman, A. Sender</creatorcontrib><creatorcontrib>Feinberg, Stan</creatorcontrib><creatorcontrib>Hayden, Dana M.</creatorcontrib><creatorcontrib>Chadi, Sami A.</creatorcontrib><creatorcontrib>Demyttenaere, Sebastian</creatorcontrib><creatorcontrib>Samuel, Louise</creatorcontrib><creatorcontrib>Hotakorzian, Nevart</creatorcontrib><creatorcontrib>Quintin, Laurence</creatorcontrib><creatorcontrib>Morin, Nancy</creatorcontrib><creatorcontrib>Faria, Julio</creatorcontrib><creatorcontrib>Ghitulescu, Gabriela</creatorcontrib><creatorcontrib>Vasilevsky, Carol-Ann</creatorcontrib><creatorcontrib>Boutros, Marylise</creatorcontrib><creatorcontrib>Bowel Stimulation Research Collaborative</creatorcontrib><title>Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>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.</description><subject>2022 SAGES Oral</subject><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Clinical trials</subject><subject>Endoscopy</subject><subject>Flatulence - complications</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ileostomy - methods</subject><subject>Ileus - epidemiology</subject><subject>Ileus - etiology</subject><subject>Ileus - prevention & control</subject><subject>Intervention</subject><subject>Intestines</subject><subject>Length of stay</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative period</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1DAUhS0EosPAC7BAltiwaIr_MrFZIEEFLVIlNrC2HOdmcOXYwXaKyhvw1jhMaYEFK1s-3z2-Rwehp5ScUEK6l5kQsRMNYawhqqWkae-hDRWcNYxReR9tiOKkYZ0SR-hRzpek8oq2D9ERb5UULaMb9ONt_AYe5-KmxZviYsA9jDEB9jHO2HmIucTpGlsf81KfS8QJhsUCnldlhlSnrmAll_wKG1x9irMQCqRjnF3Ye2h678IAwzFOJgxxct9hwDaGkqL39VqSM_4xejAan-HJzblFn9-_-3R63lx8PPtw-uaisaITpRm44mJnWWeVoXZQIKxkbEfagTKpbI1PZQ-9VXSUauSCj1a0nIJVPeG9oHyLXh9856WfYFg3TcbrObnJpGsdjdN_K8F90ft4pRVXhJLV4MWNQYpfF8hFTy5b8N4EiEvWrCNCdpSqXUWf_4NexiWFGk8zSWTXClk72iJ2oGyKOScYb5ehRK9N60PTujatfzWt2zr07M8YtyO_q60APwC5SmEP6e7v_9j-BMIJt50</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Garfinkle, Richard</creator><creator>Demian, Marie</creator><creator>Sabboobeh, Sarah</creator><creator>Moon, Jeongyoon</creator><creator>Hulme-Moir, Michael</creator><creator>Liberman, A. Sender</creator><creator>Feinberg, Stan</creator><creator>Hayden, Dana M.</creator><creator>Chadi, Sami A.</creator><creator>Demyttenaere, Sebastian</creator><creator>Samuel, Louise</creator><creator>Hotakorzian, Nevart</creator><creator>Quintin, Laurence</creator><creator>Morin, Nancy</creator><creator>Faria, Julio</creator><creator>Ghitulescu, Gabriela</creator><creator>Vasilevsky, Carol-Ann</creator><creator>Boutros, Marylise</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8006-321X</orcidid></search><sort><creationdate>20230501</creationdate><title>Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial</title><author>Garfinkle, Richard ; Demian, Marie ; Sabboobeh, Sarah ; Moon, Jeongyoon ; Hulme-Moir, Michael ; Liberman, A. Sender ; Feinberg, Stan ; Hayden, Dana M. ; Chadi, Sami A. ; Demyttenaere, Sebastian ; Samuel, Louise ; Hotakorzian, Nevart ; Quintin, Laurence ; Morin, Nancy ; Faria, Julio ; Ghitulescu, Gabriela ; Vasilevsky, Carol-Ann ; Boutros, Marylise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-d39346c27c9a1cd9e4c822605d1289c14318bebc91f89f343fc4531ec9b03b413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>2022 SAGES Oral</topic><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Clinical trials</topic><topic>Endoscopy</topic><topic>Flatulence - complications</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ileostomy - methods</topic><topic>Ileus - epidemiology</topic><topic>Ileus - etiology</topic><topic>Ileus - prevention & control</topic><topic>Intervention</topic><topic>Intestines</topic><topic>Length of stay</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative period</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garfinkle, Richard</creatorcontrib><creatorcontrib>Demian, Marie</creatorcontrib><creatorcontrib>Sabboobeh, Sarah</creatorcontrib><creatorcontrib>Moon, Jeongyoon</creatorcontrib><creatorcontrib>Hulme-Moir, Michael</creatorcontrib><creatorcontrib>Liberman, A. Sender</creatorcontrib><creatorcontrib>Feinberg, Stan</creatorcontrib><creatorcontrib>Hayden, Dana M.</creatorcontrib><creatorcontrib>Chadi, Sami A.</creatorcontrib><creatorcontrib>Demyttenaere, Sebastian</creatorcontrib><creatorcontrib>Samuel, Louise</creatorcontrib><creatorcontrib>Hotakorzian, Nevart</creatorcontrib><creatorcontrib>Quintin, Laurence</creatorcontrib><creatorcontrib>Morin, Nancy</creatorcontrib><creatorcontrib>Faria, Julio</creatorcontrib><creatorcontrib>Ghitulescu, Gabriela</creatorcontrib><creatorcontrib>Vasilevsky, Carol-Ann</creatorcontrib><creatorcontrib>Boutros, Marylise</creatorcontrib><creatorcontrib>Bowel Stimulation Research Collaborative</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garfinkle, Richard</au><au>Demian, Marie</au><au>Sabboobeh, Sarah</au><au>Moon, Jeongyoon</au><au>Hulme-Moir, Michael</au><au>Liberman, A. Sender</au><au>Feinberg, Stan</au><au>Hayden, Dana M.</au><au>Chadi, Sami A.</au><au>Demyttenaere, Sebastian</au><au>Samuel, Louise</au><au>Hotakorzian, Nevart</au><au>Quintin, Laurence</au><au>Morin, Nancy</au><au>Faria, Julio</au><au>Ghitulescu, Gabriela</au><au>Vasilevsky, Carol-Ann</au><au>Boutros, Marylise</au><aucorp>Bowel Stimulation Research Collaborative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>37</volume><issue>5</issue><spage>3934</spage><epage>3943</epage><pages>3934-3943</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35984521</pmid><doi>10.1007/s00464-022-09510-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8006-321X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Surgical endoscopy, 2023-05, Vol.37 (5), p.3934-3943 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9390101 |
| source | MEDLINE; SpringerLink (Online service) |
| subjects | 2022 SAGES Oral Abdomen Abdominal Surgery Adolescent Adult Clinical trials Endoscopy Flatulence - complications Gastroenterology Gynecology Hepatology Hospitals Humans Ileostomy - methods Ileus - epidemiology Ileus - etiology Ileus - prevention & control Intervention Intestines Length of stay Medicine Medicine & Public Health Ostomy Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Postoperative period Proctology Surgery |
| title | Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T05%3A19%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Bowel%20stimulation%20before%20loop%20ileostomy%20closure%20to%20reduce%20postoperative%20ileus:%20a%20multicenter,%20single-blinded,%20randomized%20controlled%20trial&rft.jtitle=Surgical%20endoscopy&rft.au=Garfinkle,%20Richard&rft.aucorp=Bowel%20Stimulation%20Research%20Collaborative&rft.date=2023-05-01&rft.volume=37&rft.issue=5&rft.spage=3934&rft.epage=3943&rft.pages=3934-3943&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-022-09510-5&rft_dat=%3Cproquest_pubme%3E2808754809%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2808754809&rft_id=info:pmid/35984521&rfr_iscdi=true |