Intestinal motility distal of a deviating ileostomy after rectal resection with the construction of a primary anastomosi
- PDF / 206,749 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 7 Downloads / 167 Views
SHORT COMMUNICATION
Intestinal motility distal of a deviating ileostomy after rectal resection with the construction of a primary anastomosis: results of the prospective COLO-MOVE study T. A. Burghgraef 1,2
&
F. J. Amelung 3 & P. M. Verheijen 1 & I. A. M. J. Broeders 1 & E. C. J. Consten 1,2
Accepted: 20 May 2020 # The Author(s) 2020
Abstract Purpose No consensus exists regarding the use of preoperative bowel preparation for patients undergoing a low anterior resection (LAR). Several comparative studies show similar outcomes when a single time enema (STE) is compared with mechanical bowel preparation (MBP). It is hypothesized that STE is comparable with MBP due to a decrease in intestinal motility distal of a newly constructed diverting ileostomy (DI). Methods In this prospective single-centre cohort study, patients undergoing a LAR with primary anastomosis and DI construction were given a STE 2 h pre-operatively. Radio-opaque markers were inserted in the efferent loop of the DI during surgery, and plain abdominal X-rays were made during the first, third, fifth and seventh postoperative day to visualize intestinal motility. Results Thirty-nine patients were included. Radio-opaque markers were situated in the ileum or right colon in 100%, 100% and 97.1% of the patients during respectively the first, third and fifth postoperative day. One patient had its most distal marker situated in the left colon during day five. In none of the patients, the markers were seen distal of the anastomosis. Conclusion Intestinal motility distally of the DI is decreased in patients who undergo a LAR resection with the construction of an anastomosis and DI, while preoperatively receiving a STE. Keywords Rectal neoplasms . Gastrointestinal motility . Bowel preparation
Introduction In colorectal resections, bowel preparation is used to clean the colon of faeces, thereby preventing the passage of faeces across the anastomosis, aiming to reduce anastomotic leakage. Mechanical bowel preparation (MBP) can safely be omitted in colon resections, despite a recent suggestion of using the combination of oral antibiotics and MBP [1, 2]. However, discussion
T. A. Burghgraef and F. J. Amelung contributed equally to this work. * T. A. Burghgraef [email protected] 1
Department of Surgery, Meander Medical Center, Maatweg 3, 3813, TZ Amersfoort, the Netherlands
2
Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713, GZ Groningen, the Netherlands
3
Department of Surgery, University Medical Center, Utrecht, the Netherlands
remains regarding the use of bowel preparation in rectal cancer surgery due to the high risk of anastomotic leakage [2]. MBP is not harmless: hypovolemia, electrolyte imbalances, renal failure and discomfort for the patient have been reported [3, 4]. In addition, MBP might not reduce gut microbial flora, but liquefy faeces, thereby increasing the risk of spillage and intraabdominal contamination [5]. Despite these adverse effects, omission of colon preparation does not seem feasible, since a
Data Loading...
