Afferent Loop Stimulation Prior to Ileostomy Closure

Abrisqueta, Jesús; Abellán, Israel; Frutos, María Dolores; Luján, Juan; Parrilla, Pascual

doi:10.1016/j.cireng.2012.09.002

Cited by 2 publications

(14 citation statements)

References 14 publications

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“…The mean time to passing flatus or stool was significantly lower in two out of three studies [38,44], but the mean time to tolerance of liquids did not significantly differ between the intervention and control groups in the two studies reporting this outcome [42,44]. The results of the case reports matched the results of the comparative studies [37,41].…”

Section: Time To Restoration Of Bowel Functionmentioning

confidence: 76%

“…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%

“…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.…”

Section: Description Of the Interventionmentioning

confidence: 99%

“…The volumes used ranged from 50 to 500 ml per stimulation. Administration of saline was via a syringe [37,38] or catheter [39,41,43,44]. The overall duration of the intervention ranged from 2 weeks to 3 months before ileostomy closure.…”

Section: Description Of the Interventionmentioning

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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Section: Time To Restoration Of Bowel Functionmentioning

confidence: 76%

Section: Search and Study Selectionmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Description Of the Interventionmentioning

confidence: 99%

Section: Description Of the Interventionmentioning

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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Loop ileostomy-mediated fecal stream diversion is associated with microbial dysbiosis

et al. 2017

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Loop ileostomy is an effective procedure to protect downstream intestinal anastomoses. Ileostomy reversal surgery is often performed within 12 months of formation but is associated with substantial morbidity due to severe post-surgical complications. Distal ileum is deprived of enteral nutrition and rendered inactive, often becoming atrophied and fibrotic. This study aimed to investigate the microbial and morphological changes that occur in the defunctioned ileum following loop ileostomy-mediated fecal stream diversion. Functional and defunctioned ileal resection tissue was obtained at the time of loop-ileostomy closure. Intrapatient comparisons, including histological assessment of morphology and epithelial cell proliferation, were performed on paired samples using the functional limb as control. Mucosal-associated microflora was quantified via determination of 16S rRNA gene copy number using qPCR analysis. DGGE with Sanger sequencing and qPCR methods profiled microflora to genus and phylum level, respectively. Reduced villous height and proliferation confirmed atrophy of the defunctioned ileum. DGGE analysis revealed that the microflora within defunctioned ileum is less diverse and convergence between defunctioned microbiota profiles was observed. Candidate Genera, notably Clostridia and Streptococcus, reduced in relative terms in defunctioned ileum. We conclude that Ileostomy-associated nutrient deprivation results in dysbiosis and impaired intestinal renewal in the defunctioned ileum. Altered host-microbial interactions at the mucosal surface likely contribute to the deterioration in homeostasis and thus may underpin numerous postoperative complications. Strategies to sustain the microflora before reanastomosis should be investigated.

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Afferent Loop Stimulation Prior to Ileostomy Closure

Cited by 2 publications

References 14 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

Loop ileostomy-mediated fecal stream diversion is associated with microbial dysbiosis

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