Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Grass, Fabian; Pache, Basile; Butti, Fabio; Solà, Josep; Hahnloser, Dieter; Demartines, Nicolas

doi:10.1007/s00423-018-1744-4

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…In a recent systematic review and meta-analysis conducted by Richard Garfinkle(4), the pooled estimate of POI was 8% (range from 6.7% to 12.4% varied by definition). The incidence of POI in our study is 9.7%, which is in accordance with Richard's study and many previous series (25,26). Aside from lengthen time of stay, delayed recovery of gastrointestinal function is related with increased healthcare costs and risk for other morbidities (27).…”

Section: Discussionsupporting

confidence: 92%

Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

Liu¹,

Liang²,

Lv³

et al. 2021

Preprint

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Objective: The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods: This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent Reinfusion with Succus Entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results: There was no significant difference in the incidence of postoperative ileus between Succus Entericus Reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 1.10 hours) is significantly shorter than the control group (32.3 ± 0.97, hours p= 0.004). Compared with the control group (5.52 (4.0-7.0)days), postoperative length of stay in the SER group was 4.90 (3.0-7.0)days (p= 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p=0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions: Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

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Section: Discussionsupporting

confidence: 92%

Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

Liu¹,

Liang²,

Lv³

et al. 2021

Preprint

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“…Our group previously studied effects of fluid balance on postoperative outcomes after ileostomy takedown. Both excess fluids and weight gain were found to be independent predictors of postoperative ileus and emphasize the importance of stringent fluid management [6].…”

Section: Discussionmentioning

confidence: 84%

“…Fluid management standards in patients undergoing major surgery have changed in the last years. Several studies revealed a direct relationship between perioperative fluid balance and postoperative adverse events [1][2][3][4][5][6]. Enhanced…”

Section: Introductionmentioning

confidence: 99%

Correlation of postoperative fluid balance and weight and their impact on outcomes

Butti

Pache

Winiker

et al. 2020

Langenbecks Arch Surg

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Introduction Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes. Methods All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression. Results One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049). Conclusion Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.

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“…Morbidity was graded based on severity of complications as suggested and validated by Dindo et al [13]. Majority of the earlier studies showed goal-directed fluid management improves the patient's outcome (reduces postoperative complications, lactate level, length of hospital stay, ICU stay, days to oral intake, day of return of bowel movement, and mortality) [22–25, 29]. There was no difference between the three groups with respect to development of MODS or survival.…”

Section: Discussionmentioning

confidence: 99%

Goal-Directed vs Traditional Approach to Intraoperative Fluid Therapy during Open Major Bowel Surgery: Is There a Difference?

Sujatha

Nileshwar

Krishna

et al. 2019

Anesthesiology Research and Practice

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Introduction Optimum perioperative fluid therapy is important to improve the outcome of the surgical patient. This study prospectively compared goal-directed intraoperative fluid therapy with traditional fluid therapy in general surgical patients undergoing open major bowel surgery. Methodology Patients between 20 and 70 years of age, either gender, ASA I and II, and scheduled for elective open major bowel surgery were included in the study. Patients who underwent laparoscopic and other surgeries were excluded. After routine induction of general anaesthesia, the patients were randomised to either the control group (traditional fluid therapy), the FloTrac group (based on stroke volume variation), or the PVI group (based on pleth variability index). Fluid input and output, recovery characteristics, and complications were noted. Results 306 patients, with 102 in each group, were enrolled. Five patients (control (1), FloTrac (2), and PVI (2)) were inoperable and were excluded. Demographic data, ASA PS, anaesthetic technique, duration of surgery, and surgical procedures were comparable. The control group received significantly more crystalloids (3200 ml) than the FloTrac (2000 ml) and PVI groups (1875 ml), whereas infusion of colloids was higher in the FloTrac (400–700 ml) and PVI (200–500 ml) groups than in the control group (0–500 ml). The control group had significantly positive net fluid balance intraoperatively (2500 ml, 9 ml/kg/h) compared to the FloTrac (1515 ml, 5.4 ml/kg/h) and PVI (1420 ml, 6 ml/kg/h) groups. Days to ICU stay, HDU stay, return of bowel movement, oral intake, morbidity, duration of hospital stay, and survival rate were comparable. The total number of complications was not different between the three groups. Anastomotic leaks occurred more often in the Control group than in the others, but the numbers were small. Conclusions Use of goal-directed fluid management, either with FloTrac or pleth variability index results in a lower volume infusion and lower net fluid balance. However, the complication rate is similar to that of traditional fluid therapy. This trial is registered with CTRI/2018/04/013016.

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Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Cited by 19 publications

References 23 publications

Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

Correlation of postoperative fluid balance and weight and their impact on outcomes

Goal-Directed vs Traditional Approach to Intraoperative Fluid Therapy during Open Major Bowel Surgery: Is There a Difference?

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