Loop Ileostomy Closure as a 23-Hour Stay Procedure With Preoperative Efferent Limb Enteral Stimulation: A Randomized Controlled Trial.
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
16 Nov 2023
16 Nov 2023
Historique:
medline:
23
11
2023
pubmed:
23
11
2023
entrez:
23
11
2023
Statut:
aheadofprint
Résumé
Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with low complication rates, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery. This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. Randomized controlled trial. Two high-volume colorectal surgery centers. Healthy adults undergoing elective ileostomy closure, from July 2019 to January 2022. All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure including daily irrigation of efferent limb with a nutritional formula for 7 days prior to surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24). Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, postoperative morbidity and mortality. A total of 47 patients were ultimately randomized. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 day vs. 2 days, p = 0.02) and similar rates of readmission (4% vs. 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0 vs. 4%, p = 0.49), postoperative morbidity (21% vs. 22%, p = 1.00) and mortality (none in both arms). Due to COVID-19, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power. Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through stoma's efferent limb, although specific RCTs are needed to confirm this association.
Sections du résumé
BACKGROUND
BACKGROUND
Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with low complication rates, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery.
OBJECTIVES
OBJECTIVE
This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway.
DESIGN
METHODS
Randomized controlled trial.
SETTINGS
METHODS
Two high-volume colorectal surgery centers.
PATIENTS
METHODS
Healthy adults undergoing elective ileostomy closure, from July 2019 to January 2022.
INTERVENTION
METHODS
All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure including daily irrigation of efferent limb with a nutritional formula for 7 days prior to surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24).
MAIN OUTCOME MEASURES
METHODS
Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, postoperative morbidity and mortality.
RESULTS
RESULTS
A total of 47 patients were ultimately randomized. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 day vs. 2 days, p = 0.02) and similar rates of readmission (4% vs. 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0 vs. 4%, p = 0.49), postoperative morbidity (21% vs. 22%, p = 1.00) and mortality (none in both arms).
LIMITATIONS
CONCLUSIONS
Due to COVID-19, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power.
CONCLUSION
CONCLUSIONS
Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through stoma's efferent limb, although specific RCTs are needed to confirm this association.
Identifiants
pubmed: 37994456
doi: 10.1097/DCR.0000000000003111
pii: 00003453-990000000-00485
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © The ASCRS 2023.