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International Journal of Colorectal Disease

Published in:

01-11-2018 | Original Article

Protective loop ileostomy increases the risk for prolonged postoperative paralytic ileus after open oncologic rectal resection

Authors: Martin Reichert, Christian Weber, Jörn Pons-Kühnemann, Matthias Hecker, Winfried Padberg, Andreas Hecker

Published in: International Journal of Colorectal Disease | Issue 11/2018

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.

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Title: Protective loop ileostomy increases the risk for prolonged postoperative paralytic ileus after open oncologic rectal resection
Authors: Martin Reichert
Christian Weber
Jörn Pons-Kühnemann
Matthias Hecker
Winfried Padberg
Andreas Hecker
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 11/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3142-3

At a glance: The STEP trials

Springer Medicine

Protective loop ileostomy increases the risk for prolonged postoperative paralytic ileus after open oncologic rectal resection

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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