Risk Factors for Postoperative Ileus after Diverting Loop Ileostomy Closure following Rectal Cancer Surgery: A Retrospective Study

Abstract Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus (POI (+)) and patients who did not (POI (−)) after ileostomy closure were compared.Results: Fifty-nine patients were evaluated and were divided into two groups: POI (+) (n=9) and POI (−) (n=50), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications after the index surgery was significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications after the index surgery may increase the risk of postoperative ileus after ileostomy closure.

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Risk factors for postoperative ileus following loop ileostomy closure

Turkish Journal of Surgery ◽

10.47717/turkjsurg.2020.4911 ◽

2020 ◽

Vol 36 (4) ◽

pp. 333-339

Author(s):

Aydın Aktaş ◽

Cüneyt Kayaalp ◽

Mustafa Ateş ◽

Abuzer Dirican

Keyword(s):

Risk Factors ◽

Postoperative Ileus ◽

Loop Ileostomy ◽

Ileostomy Closure

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Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Nutrients ◽

10.3390/nu13020626 ◽

2021 ◽

Vol 13 (2) ◽

pp. 626

Author(s):

Ángela Rodríguez-Padilla ◽

Germán Morales-Martín ◽

Rocío Pérez-Quintero ◽

Juan Gómez-Salgado ◽

Rafael Balongo-García ◽

...

Keyword(s):

Colorectal Carcinoma ◽

Postoperative Ileus ◽

Loop Ileostomy ◽

Bowel Function ◽

Ileostomy Closure ◽

Controlled Study ◽

Control Group ◽

Double Blind ◽

Colorectal Cancer Surgery ◽

Stimulation Of

Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.

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Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study). A nationwide retrospective study of the Italian Society of Surgical Oncology – Colorectal Cancer Network Collaborative Group

Colorectal Disease ◽

10.1111/codi.15997 ◽

2021 ◽

Author(s):

Maurizio Degiuli ◽

Ugo Elmore ◽

Raffaele De Luca ◽

Paola De Nardi ◽

Mariano Tomatis ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Rectal Cancer ◽

Retrospective Study ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Surgical Oncology ◽

Italian Society ◽

Collaborative Group ◽

Cancer Network

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EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

British Journal of Surgery ◽

10.1093/bjs/znab309.098 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Pratik Bhattacharya ◽

Reza Zakaria ◽

Christopher Thompson ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Surgical Site Infection ◽

Hospital Stay ◽

Perioperative Complications ◽

Loop Ileostomy ◽

Length Of Hospital Stay ◽

Ileostomy Closure ◽

Site Infection ◽

Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

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Recurrent Intestinal Obstruction after Radiation Therapy: A Case Report and Review of the Literature

Case Reports in Surgery ◽

10.1155/2019/5198958 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

James Nguyen ◽

Amani Jambhekar ◽

Ziyad Nasrawi ◽

Prasad Gudavalli

Keyword(s):

Rectal Cancer ◽

Case Report ◽

Small Bowel ◽

Intestinal Obstruction ◽

Loop Ileostomy ◽

Neoadjuvant Chemoradiation ◽

Ileocolic Anastomosis ◽

Neoadjuvant Radiotherapy ◽

Diverting Loop Ileostomy ◽

Radiation Induced

Introduction. In patients who have undergone resection for rectal cancer after neoadjuvant radiotherapy, loop ileostomy is commonly performed with few serious complications. In rare cases, if this irradiated small bowel is strictured, reversal of the affected ileostomy can have dire consequences. We present a case of a 62-year-old male with recurrent intestinal obstruction after closure of his loop ileostomy. Case Report. RC is a 62-year-old male who initially presented with rectal cancer and underwent neoadjuvant chemoradiation prior to a laparoscopic low anterior resection with diverting loop ileostomy. He underwent elective reversal of his ileostomy and developed persistent postoperative obstruction. He underwent resection of the prior reversal site with normal-appearing dilated proximal bowel loops and collapsed distal bowel loops. He again developed an obstructive picture and underwent resection of the prior anastomosis with creation of an ileocolic anastomosis, after which he recovered well postoperatively. Conclusion. In patients who receive radiation adjuvant therapy for colon cancer, radiation-induced stricture should be considered as a cause of small bowel obstruction postoperative. In the setting of a longstanding ileostomy, evaluation of a defunctionalized distal ileum may be necessary to evaluate potential obstruction from radiation changes.

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