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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany

    Martin Reichert, Christian Weber, Winfried Padberg & Andreas Hecker

  2. Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany

    Jörn Pons-Kühnemann

  3. Department of Pulmonary and Critical Care Medicine, University Hospital of Giessen, Klinikstrasse 33, 35392, Giessen, Germany

    Matthias Hecker

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  1. Martin Reichert
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  2. Christian Weber
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Correspondence to Martin Reichert.

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As this was a retreospective analysis, all patients included were initially treated by the local standard of care. The local ethics committee gave approval to retrospectively analyze these patient data.

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Reichert, M., Weber, C., Pons-Kühnemann, J. et al. Protective loop ileostomy increases the risk for prolonged postoperative paralytic ileus after open oncologic rectal resection. Int J Colorectal Dis 33, 1551–1557 (2018). https://doi.org/10.1007/s00384-018-3142-3

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