Techniques in Coloproctology

, Volume 22, Issue 4, pp 295–300 | Cite as

Application of an enhanced recovery pathway for ileostomy closure: a case–control trial with surprising results

  • J. Slieker
  • M. Hübner
  • V. Addor
  • C. Duvoisin
  • N. Demartines
  • D. Hahnloser
Original Article
  • 58 Downloads

Abstract

Background

Enhanced recovery after surgery (ERAS) protocols have been widely validated in colorectal surgery; however, few data exist on loop ileostomy closure. The aim of this study was to compare clinical outcomes before and after introduction of ERAS for loop ileostomy closure.

Methods

Data on outcomes after loop ileostomy closure were retrospectively collected before ERAS was applied at our department (control group). These results were compared to results of patients undergoing loop ileostomy closure within the original colorectal ERAS pathway (ERAS 1 group); after analysis of these results, adaptations were made to the ERAS pathway regarding the postoperative diet, and this second category of patients was analyzed (ERAS 2 group).

Results

Forty-eight patients in the control group were compared to 46 ERAS 1 and 69 ERAS 2 patients. First stool was significantly faster in ERAS 2 group versus control and ERAS 1 group [median 1 (range 1–2) days vs 2 (2–3) days p value 0.01]. The incidence of vomiting increased from 26% in the control group to 45% in ERAS 1 group, and then decreased to 29% in the ERAS 2 group (p value 0.41). Length of stay was significantly shorter during the ERAS 2 protocol: median 4 (range 3–6) days versus 5 (4–8) days in the control group (p value < 0.01).

Conclusions

After application of the ‘colorectal’ ERAS pathway to loop ileostomy closure, results were initially not improved. Minor corrections were sufficient to avoid increased incidence of vomiting and to allow for reduced hospital stay. Uncritical extrapolation of an ERAS colorectal protocol to other types of surgery should be monitored and needs audit for corrections.

Keywords

Enhanced recovery after surgery Ileostomy Postoperative ileus 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and regional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent was not required.

References

  1. 1.
    Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38(6):1531–1541.  https://doi.org/10.1007/s00268-013-2416-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R (2014) Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg 6(9):169–174.  https://doi.org/10.4240/wjgs.v6.i9.169 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS((R))) society recommendations. World J Surg 37(2):259–284.  https://doi.org/10.1007/s00268-012-1772-0 CrossRefPubMedGoogle Scholar
  4. 4.
    Roulin D, Donadini A, Gander S et al (2013) Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg 100(8):1108–1114.  https://doi.org/10.1002/bjs.9184 CrossRefPubMedGoogle Scholar
  5. 5.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    D’Haeninck A, Wolthuis AM, Penninckx F, D’Hondt M, D’Hoore A (2011) Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg 111(3):136–141CrossRefPubMedGoogle Scholar
  7. 7.
    Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP (2008) Standardized postoperative pathway: accelerating recovery after ileostomy closure. Dis Colon Rectum 51(12):1786–1789.  https://doi.org/10.1007/s10350-008-9399-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Keller DS, Swendseid B, Khan S, Delaney CP (2014) Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway? Am J Surg 208(4):650–655.  https://doi.org/10.1016/j.amjsurg.2014.05.003 CrossRefPubMedGoogle Scholar
  9. 9.
    Loffler T, Rossion I, Bruckner T et al (2012) HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040). Ann Surg 256(5):828–835.  https://doi.org/10.1097/sla.0b013e318272df97 (discussion 835-826) CrossRefPubMedGoogle Scholar
  10. 10.
    Shelygin YA, Chernyshov SV, Rybakov EG (2010) Stapled ileostomy closure results in reduction of postoperative morbidity. Tech Coloproctol 14(1):19–23.  https://doi.org/10.1007/s10151-009-0550-y CrossRefPubMedGoogle Scholar
  11. 11.
    Markides GA, Wijetunga IU, Brown SR, Anwar S (2015) Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg 85(4):217–224.  https://doi.org/10.1111/ans.12684 CrossRefPubMedGoogle Scholar
  12. 12.
    Moghadamyeghaneh Z, Hwang GS, Hanna MH et al (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30(2):603–609.  https://doi.org/10.1007/s00464-015-4247-1 CrossRefPubMedGoogle Scholar
  13. 13.
    Oh HK, Ihn MH, Son IT, Park JT, Lee J, Kim DW, Kang SB (2016) Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study. Surg Endosc 30(3):1086–1093.  https://doi.org/10.1007/s00464-015-4302-y CrossRefPubMedGoogle Scholar
  14. 14.
    Kummer A, Slieker J, Grass F, Hahnloser D, Demartines N, Hubner M (2016) Enhanced recovery pathway for right and left colectomy: comparison of functional recovery. World J Surg.  https://doi.org/10.1007/s00268-016-3563-5 PubMedGoogle Scholar
  15. 15.
    Cookson MS, Chang SS, Wells N, Parekh DJ, Smith JA Jr (2003) Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol 169(1):101–104.  https://doi.org/10.1097/01.ju.0000039521.77948.f9 CrossRefPubMedGoogle Scholar
  16. 16.
    Hollenbeck BK, Miller DC, Taub D et al (2005) Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol 174(4 Pt 1):1231–1237 (discussion 1237) CrossRefPubMedGoogle Scholar
  17. 17.
    Lee KL, Freiha F, Presti JC Jr, Gill HS (2004) Gender differences in radical cystectomy: complications and blood loss. Urology 63(6):1095–1099.  https://doi.org/10.1016/j.urology.2004.01.029 CrossRefPubMedGoogle Scholar
  18. 18.
    Parekh DJ, Clark T, O’Connor J, Jung C, Chang SS, Cookson M, Smith JA Jr (2002) Orthotopic neobladder following radical cystectomy in patients with high perioperative risk and co-morbid medical conditions. J Urol 168(6):2454–2456.  https://doi.org/10.1097/01.ju.0000035645.96508.42 CrossRefPubMedGoogle Scholar
  19. 19.
    Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174.  https://doi.org/10.1016/j.eururo.2008.07.031 CrossRefPubMedGoogle Scholar
  20. 20.
    Soulie M, Straub M, Game X, Seguin P, De Petriconi R, Plante P, Hautmann RE (2002) A multicenter study of the morbidity of radical cystectomy in select elderly patients with bladder cancer. J Urol 167(3):1325–1328CrossRefPubMedGoogle Scholar
  21. 21.
    Svatek RS, Fisher MB, Williams MB et al (2010) Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology 76(6):1419–1424.  https://doi.org/10.1016/j.urology.2010.02.053 CrossRefPubMedGoogle Scholar
  22. 22.
    Danna BJ, Wood EL, Baack Kukreja JE, Shah JB (2016) The future of enhanced recovery for radical cystectomy: current evidence, barriers to adoption, and the next steps. Urology.  https://doi.org/10.1016/j.urology.2016.04.038 PubMedGoogle Scholar
  23. 23.
    Bhalla A, Peacock O, Tierney GM et al (2015) Day-case closure of ileostomy: feasible, safe and efficient. Colorectal Dis 17(9):820–823.  https://doi.org/10.1111/codi.12961 CrossRefPubMedGoogle Scholar
  24. 24.
    Berger NG, Chou R, Toy ES, Ludwig KA, Ridolfi TJ, Peterson CY (2017) Loop ileostomy closure as an overnight procedure: Institutional comparison with the national surgical quality improvement project data set. Dis Colon Rectum 60(8):852–859.  https://doi.org/10.1097/DCR.0000000000000793 CrossRefPubMedGoogle Scholar
  25. 25.
    Adam MA, Lee LM, Kim J et al (2016) Alvimopan provides additional improvement in outcomes and cost savings in enhanced recovery colorectal surgery. Ann Surg 264(1):141–146.  https://doi.org/10.1097/SLA.0000000000001428 CrossRefPubMedGoogle Scholar
  26. 26.
    Nguyen DL, Maithel S, Nguyen ET, Bechtold ML (2015) Does alvimopan enhance return of bowel function in laparoscopic gastrointestinal surgery? A meta-analysis. Ann Gastroenterol 28(4):475–480PubMedPubMedCentralGoogle Scholar
  27. 27.
    Labgaa I, Jarrar G, Joliat GR et al (2016) Implementation of enhanced recovery (ERAS) in colorectal surgery has a positive impact on non-ERAS liver surgery patients. World J Surg 40(5):1082–1091.  https://doi.org/10.1007/s00268-015-3363-3 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Visceral SurgeryUniversity Hospital CHUV LausanneLausanneSwitzerland

Personalised recommendations