Stephanie Pappas, MD, Fia Yi, MD, Kelly Klinker, MD, David N Armstrong, MD. Georgia Colon and Rectal Surgical Clinic
Purpose: To evaluate the efficacy of Enterg (Alvimopan) in decreasing postoperative ileus and hospital stay after loop ileotomy closure. Loop ileostomy reversal is a simple and standard procedure with little technical variability between surgeons. This provides a homogenous study population in which to examine the impact of Entereg on postoperative ileus and length of hospital stay.
Methods: Patients undergoing loop ileostomy closure were studied. Lopop ileostomy had been created aafter either proctocolectomy and ileal J Pouch creation or proctosigmoidectomy and colo-anal anastomosis for retal carcinoma. Loop ileostomy reversal was performed using a circum-stomal incision, so avoiding a full laparotomy. Enetreg was given 1 hour pre-op and q 12 hours from postop day 1 in study patients (Entereg patients) and patients not receiving Entereg were used as controls.Time to flatus was recorded as an index of postoperative ileus (POI) and length of stay was recorded in Entereg and Control patients. 30 day readmission was also recorded in all patients. Data was analysed using Wilcoxon analysis.
Results Twenty five patients were studied. Six patients had a loop ileostomy after J pouch and 19 patients after colo-anal anastomosis for carcinoma. POI was 2.6±0.2 days in controls and 1.6±0.2 in Entereg patients (p<0.005). Length of stay was 5.4±0.5 days in controls and 3.4±0.2 days in Entereg patients (p<0.0001). Two pateints were readmitted within 30 days after discharge, both in the control group.
Conclusion. Entereg (Alvimopan) accelerated recovery from POI and decreases LOS after loop ileocstomy reversal. Discharge occurred on average 48 hours sooner in Enterg patients compard to controls. The accelerated recovery from POI and shorter LOS does not result in more frequent readmission in Entereg patients.
Program Number: P110