Application of an enhanced recovery pathway for ileostomy closure: a case–control trial with surprising results
- 58 Downloads
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.
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).
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).
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.
KeywordsEnhanced recovery after surgery Ileostomy Postoperative ileus
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
For this type of study formal consent was not required.
- 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
- 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
- 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