Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study
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ORIGINAL ARTICLE
Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study Paola Germani1 · Annalisa Zucca1 · Fabiola Giudici1 · Susanna Terranova1 · Marina Troian1 · Natasa Samardzic1 · Marco Greco2 · Jurij Janez3 · Camilla Gasperini4 · Emanuela Cagnazzo5 · Andrea Vignali6 · Fabio Giannone Codiglione6 · Andrea Armellini7 · Uberto Romario Fumagalli7 · Riccardo Rosati6 · Giuseppe Piccinni5 · Jacques Megevand4 · Ales Tomazic3 · Francesco Corcione2 · Silvia Palmisano1 · Nicolò de Manzini1 Received: 9 May 2020 / Accepted: 1 July 2020 © The Author(s) 2020, corrected publication July 2020
Abstract Patients undergoing colon resection are often concerned about their functional outcomes after surgery. The primary aim of this prospective, multicentric study was to assess the intestinal activity and health-related quality-of-life (HRQL) after ileocecal valve removal. The secondary aim was to evaluate any vitamin B12 deficiency. The study included patients undergoing right colectomy, extended right colectomy and ileocecal resection for either neoplastic or benign disease. Selected items of GIQLI and EORTC QLQ-CR29 questionnaires were used to investigate intestinal activity and HRQL before and after surgery. Blood samples for vitamin B12 level were collected before and during the follow-up period. The empirical rule effect size (ERES) method was used to explain the clinical effect of statistical results. Linear mixed effect (LME) model for longitudinal data was applied to detect the most important parameters affecting the total score. A total of 158 patients were considered. Applying the ERES method, the analysis of both questionnaires showed clinically and statistically significant improvement of HRQL at the end of the follow-up period. Applying the LME model, worsening of HRQL was correlated with female gender and ileum length when using GIQLI questionnaire, and with female gender, open approach, and advanced cancer stage when using the EORTC QLQ-CR29 questionnaire. No significant deficiency in vitamin B12 levels was observed regardless of the length of surgical specimen. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. Keywords Ileocecal valve · Ileocecal junction · Vitamin B12 · Quality of life · GIQLI · EORTC-QLQ-CR29 * Paola Germani [email protected] 1
General Surgery Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, University Hospital of Trieste, Trieste, Italy
2
General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
3
Department of Abdominal Surgery, Ljubljana University Medical Center, Ljubljana, Slovenia
4
General Surgery, San Pio X Humanitas Research Hospi
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