Abstract
ObjectiveThe study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score.MethodsThis study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent reinfusion with succus entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group.ResultsThere was no significant difference in the incidence of postoperative ileus between succus entericus reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 6.02 h) is significantly shorter than the control group (32.3 ± 6.26, hours p = 0.004). Compared with the control group (5.52 (4.0–7.0) days), postoperative length of stay in the SER group was 4.90 (3.0–7.0)days (p = 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p = 0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference.ConclusionsSelf-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.
Highlights
Rectal cancer is one of the most common carcinomas worldwide [1]
Resulting from nociceptors stimulation by direct intestine manipulation and muscular layer infiltration by inflammatory cytokines, delayed recovery of gastrointestinal function can last up to 5 days after surgery, which leads to increased perioperative morbidity and health care costs [6, 7]
Low anterior resection syndrome (LARS) refers to a combination of symptoms consist of incontinence for stool and/ or feces, increased frequency of bowel movements, and urgency after low anterior resection for rectal cancer [8, 9]
Summary
Prophylactic ostomy is widely applied to reduce the morbidity and mortality associated with anastomotic complications after proctectomy, especially for patients with low rectal carcinoma or neoadjuvant therapy. Both ileostomy and transverse colostomy are effective for fecal diversion, loop ileostomy. Postoperative ileus(POI) with the reported incidence varies from 8.0 to 32% [4, 5] is the most common complication after loop ileostomy closure. Patients may have diarrhea, urgency, or incontinence due to long-term. Low anterior resection syndrome (LARS) refers to a combination of symptoms consist of incontinence for stool and/ or feces, increased frequency of bowel movements, and urgency after low anterior resection for rectal cancer [8, 9]. With a reported incidence of up to 60%, LARS has a detrimental impact on patients’ quality of life [10]
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