Richard Garfinkle, MD, Gregory Sigler, Nancy Morin, MD, Gabriela Ghitulescu, MD, Sahir Bhatnagar, PhD, Julio Faria, MD, Philip Gordon, MD, Carol-Ann Vasilevsky, MD, Marylise Boutros, MD. Sir Mortimer B. Davis Jewish General Hospital
INTRODUCTION: It has been hypothesized that the structural and functional changes that develop in the defunctioned segment of bowel may contribute to the development of postoperative ileus (POI) after loop ileostomy closure (LIC). As such, longer intersurgery interval between ileostomy creation and LIC may increase POI.
METHODS AND PROCEDURES: After institutional review board approval, all patients who underwent LIC at a single institution between 2007-2017 were identified. The primary endpoint, primary POI, was defined as either a) being kept nil-per-os on or after postoperative day 3 for symptoms of nausea / vomiting, distension, and/or obstipation or b) having a nasogastric tube (NGT) inserted, without postoperative obstruction or sepsis. Secondary endpoints included length of hospital stay (LOS) and non-POI related morbidity. Patients who left the operating room with a NGT, had a planned laparotomy with a concomitant procedure at the time of LIC, had a total proctocolectomy as their index operation, or had secondary POI, were excluded. Patients were then divided into two groups based on timing from the index operation to LIC (<6 months vs. >6 months).
RESULTS: Two hundred fifty-nine patients underwent LIC – 92 within 6 months of ileostomy creation, and 167 after 6 months. The median age was 65.2 (56.0-73.0) years and 58.7% were male. Patients with >6 months intersurgery interval were more likely to have a diagnosis of colorectal cancer (89.8% vs. 77.2%, p=0.010), to have had an open index colorectal resection (88.6% vs. 76.1%, p=0.040), and to have suffered an anastomotic leak after the index resection (15.0% vs. 4.3%, p=0.012). POI was observed in 18.9% of patients, while overall 30-day postoperative and non-POI related morbidity were 39.5% and 23.6%, respectively. POI was more frequently observed in patients with >6 months intersurgery interval (22.8% vs. 12.0%, p=0.046). Completion of adjuvant chemotherapy prior to LIC was the only other predictor of POI on univariate analysis (51.0% vs. 34.9%, p=0.049). In all patients, POI resulted in a greater median LOS (9 (8-16.5) vs. 5 (4-6) days, p<0.001) but was not associated with an increase in non-POI related morbidity (27.3% vs. 22.4%, p=0.55). On multivariable regression, intersurgery interval >6 months remained a significant predictor of POI (OR 2.57, 95% CI 1.21-5.91).
CONCLUSION(S): Intersurgery interval >6 months is an independent predictor of primary POI after LIC. Such patients may benefit from preoperative bowel stimulation; a novel intervention being evaluated to decrease POI after LIC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87958
Program Number: P206
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster