Self-administered succus entericus reinfusion before ileostomy closure improves short-term outcomes

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Abstract

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 ± 6.02 h) is significantly shorter than the control group (32.3 ± 6.26, 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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Most cited references 37

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Colorectal cancer

Evelien Dekker, Pieter Tanis, Jasper Vleugels … (2019)

Several decades ago, colorectal cancer was infrequently diagnosed. Nowadays, it is the world's fourth most deadly cancer with almost 900 000 deaths annually. Besides an ageing population and dietary habits of high-income countries, unfavourable risk factors such as obesity, lack of physical exercise, and smoking increase the risk of colorectal cancer. Advancements in pathophysiological understanding have increased the array of treatment options for local and advanced disease leading to individual treatment plans. Treatments include endoscopic and surgical local excision, downstaging preoperative radiotherapy and systemic therapy, extensive surgery for locoregional and metastatic disease, local ablative therapies for metastases, and palliative chemotherapy, targeted therapy, and immunotherapy. Although these new treatment options have doubled overall survival for advanced disease to 3 years, survival is still best for those with non-metastasised disease. As the disease only becomes symptomatic at an advanced stage, worldwide organised screening programmes are being implemented, which aim to increase early detection and reduce morbidity and mortality from colorectal cancer.

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Neuroimmune mechanisms in postoperative ileus.

Paul de Jonge, G Boeckxstaens (2009)

Postoperative ileus (POI) is a common clinical condition arising after almost every abdominal surgical procedure, leading to increased patient morbidity and prolonged hospitalisation. Recent advances in insight into the underlying pathophysiology have identified intestinal inflammation triggered by handling of the intestine as the main mechanism. Not only does the local inflammatory process compromise the contractile activity of the handled intestine, but it also activates inhibitory neural pathways and possibly triggers inflammation at distant untouched areas, leading to a generalised impairment of gastrointestinal motility. Macrophages residing in the muscularis externa and mast cells are the key players in this inflammatory cascade. Pharmacological interventions preventing the activation of these immune cells reduce the influx of leucocytes into the intestine, an effect associated with a reduction of the duration of POI. New potential therapeutic strategies to shorten POI based on these new insights will undoubtedly enter the clinical arena soon.

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The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases.

Sanjay Purkayastha, Santhini Jeyarajah, Andre Chow … (2009)

Loop ileostomies are used currently in surgical practice to reduce the consequences of distal anastomotic failure following colorectal resection. It is often assumed that reversal of a loop ileostomy is a simple and safe procedure. However, many studies have demonstrated high morbidity rates following loop ileostomy closure. The aims of this systematic review were to examine all the existing evidence in the literature on morbidity and mortality following closure of loop ileostomy. A literature search of Ovid, Embase, the Cochrane database, Google Scholar and Medline using Pubmed as the search engine was used to identify studies reporting on the morbidity of loop ileostomy closure (latest at June 15th 2008), was performed. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital-related outcomes, post-operative bowel-related complications, and other surgical and medical complications. Forty-eight studies from 18 countries satisfied the inclusion criteria. Outcomes of a total of 6,107 patients were analysed. Overall morbidity following closure of loop ileostomy was found to be 17.3% with a mortality rate of 0.4%. 3.7% of patients required a laparotomy at the time of ileostomy closure. The most common post-operative complications included small bowel obstruction (7.2%) and wound sepsis (5.0%). The consequences of anastomotic leakage following colorectal resection are severe. However, the consequences of stoma reversal are often underestimated. Surgeons should adopt a selective strategy regarding the use of defunctioning ileostomy, and counsel patients further prior to the original surgery. In this way, patients at low risk may be spared the morbidity of stoma reversal.

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Author and article information

Contributors

Dong Guo: guo.nju@hotmail.com

Journal

Journal ID (nlm-ta): BMC Surg

Journal ID (iso-abbrev): BMC Surg

Title: BMC Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2482

Publication date (Electronic): 28 December 2021

Publication date PMC-release: 28 December 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 440

Affiliations

[1 ]GRID grid.412521.1, ISNI 0000 0004 1769 1119, Department of Emergency Surgery, , The Affiliated Hospital of Qingdao University, ; Qingdao, Shandong China

[2 ]GRID grid.412521.1, ISNI 0000 0004 1769 1119, Department of Gastrointestinal Surgery, , The Affiliated Hospital of Qingdao University, ; No.16 Jiangsu Rd, Qingdao, 266000 Shandong China

[3 ]GRID grid.412521.1, ISNI 0000 0004 1769 1119, Department of Gastroenterology, , The Affiliated Hospital of Qingdao University, ; Qingdao, Shandong China

[4 ]GRID grid.412521.1, ISNI 0000 0004 1769 1119, Department of General Surgery, , The Affiliated Hospital of Qingdao University, ; Qingdao, Shandong China

Article

Publisher ID: 1444

DOI: 10.1186/s12893-021-01444-4

PMC ID: 8713408

PubMed ID: 34961502

SO-VID: 1bf86d34-3751-449c-b510-6d4dea5895cc

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 January 2021

Date accepted : 14 December 2021

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: rectal cancer ileostomy closure,succus entericus reinfusion,clinical outcomes,quality of life

Data availability:

ScienceOpen disciplines: Surgery

Keywords: rectal cancer ileostomy closure, succus entericus reinfusion, clinical outcomes, quality of life

Self-administered succus entericus reinfusion before ileostomy closure improves short-term outcomes

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Abstract

Objective

Methods

Results

Conclusions

Related collections

Asian Journal of Quality of Life (AjQoL)

Most cited references 37

Colorectal cancer

Neuroimmune mechanisms in postoperative ileus.

The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases.

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Contributors

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