Martin Reichert1, Christian Weber2, Jörn Pons-Kühnemann3, Matthias Hecker4, Winfried Padberg2, Andreas Hecker2. 1. Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany. martin.reichert@chiru.med.uni-giessen.de. 2. Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany. 3. Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany. 4. Department of Pulmonary and Critical Care Medicine, University Hospital of Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
Abstract
PURPOSE: Postoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative paralytic ileus remains multifactorial. METHODS: We present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative paralytic ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative paralytic ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model. RESULTS: Of 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative paralytic ileus after oncologic rectal resection (p = 0.047). Odds ratio for prolonged postoperative paralytic ileus in patients with ileostomy was 4.96 [95% CI 1.02-24.03]. CONCLUSIONS: Although the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
PURPOSE: Postoperative gut dysmotility is a physiologic and frequent temporary reaction after major abdominal surgery. If paralysis merges into a prolonged ileus state, it causes significant morbidity and subsequently worse outcome and discomfort for the patients. Pathophysiology of pathologic prolonged postoperative paralytic ileus remains multifactorial. METHODS: We present a retrospective single-center analysis of patients, who underwent a primary open oncologic anterior rectal resection with primary anastomosis with or without defunctioning loop ileostomy during a 43-month period of observation. Primary endpoint was the rate of prolonged postoperative paralytic ileus, defined by the intravenous administration of neostigmine. Confounders for regression analysis were assessed by univariate analysis and correlations between confounders were examined. Odds ratio for prolonged postoperative paralytic ileus in patients with defunctioning loop ileostomy was estimated by a logistic regression model. RESULTS: Of 101 patients (62 male), 62 (61.39%) received defunctioning loop ileostomy. In univariate analysis, male gender and patients with ileostomy showed more frequently prolonged paralysis by tendency (both p = 0.07). Logistic regression analysis proves the influence of a defunctioning ileostomy on the development of prolonged postoperative paralytic ileus after oncologic rectal resection (p = 0.047). Odds ratio for prolonged postoperative paralytic ileus in patients with ileostomy was 4.96 [95% CI 1.02-24.03]. CONCLUSIONS: Although the construction of defunctioning loop ileostomies during rectal resection is a safe, uncomplicated surgical procedure, they can cause significant postoperative morbidity for the patients. High fluid and electrolyte loss are well-known complications, but herewith we raise the evidence for prolonged gut paralysis in patients with defunctioning loop ileostomy.
Authors: A M Wolthuis; G Bislenghi; S Fieuws; A de Buck van Overstraeten; G Boeckxstaens; A D'Hoore Journal: Colorectal Dis Date: 2016-01 Impact factor: 3.788
Authors: Rebecca L Siegel; Kimberly D Miller; Stacey A Fedewa; Dennis J Ahnen; Reinier G S Meester; Afsaneh Barzi; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2017-03-01 Impact factor: 508.702
Authors: Zhobin Moghadamyeghaneh; Grace S Hwang; Mark H Hanna; Michael Phelan; Joseph C Carmichael; Steven Mills; Alessio Pigazzi; Michael J Stamos Journal: Surg Endosc Date: 2015-05-28 Impact factor: 4.584
Authors: Norbert Hüser; Christoph W Michalski; Mert Erkan; Tibor Schuster; Robert Rosenberg; Jörg Kleeff; Helmut Friess Journal: Ann Surg Date: 2008-07 Impact factor: 12.969
Authors: Andrea Carolina Quiroga-Centeno; Kihara Alejandra Jerez-Torra; Pedro Antonio Martin-Mojica; Sergio Andrés Castañeda-Alfonso; María Emma Castillo-Sánchez; Oscar Fernando Calvo-Corredor; Sergio Alejandro Gómez-Ochoa Journal: World J Surg Date: 2020-05 Impact factor: 3.352
Authors: Guido Woeste; Teresa Schreckenbach; Amal Rhemouga; Stefan Buettner; Wolf O Bechstein Journal: BMC Geriatr Date: 2021-01-19 Impact factor: 3.921