PMID- 30112664
OWN - NLM
STAT- MEDLINE
DCOM- 20190121
LR  - 20190121
IS  - 1432-1262 (Electronic)
IS  - 0179-1958 (Linking)
VI  - 33
IP  - 11
DP  - 2018 Nov
TI  - Protective loop ileostomy increases the risk for prolonged postoperative
      paralytic ileus after open oncologic rectal resection.
PG  - 1551-1557
LID - 10.1007/s00384-018-3142-3 [doi]
AB  - PURPOSE: Postoperative gut dysmotility is a physiologic and frequent temporary
      reaction after major abdominal surgery. If paralysis merges into a prolonged
      ileus state, it causes significant morbidity and subsequently worse outcome and
      discomfort for the patients. Pathophysiology of pathologic prolonged
      postoperative paralytic ileus remains multifactorial. METHODS: We present a
      retrospective single-center analysis of patients, who underwent a primary open
      oncologic anterior rectal resection with primary anastomosis with or without
      defunctioning loop ileostomy during a 43-month period of observation. Primary
      endpoint was the rate of prolonged postoperative paralytic ileus, defined by the 
      intravenous administration of neostigmine. Confounders for regression analysis
      were assessed by univariate analysis and correlations between confounders were
      examined. Odds ratio for prolonged postoperative paralytic ileus in patients with
      defunctioning loop ileostomy was estimated by a logistic regression model.
      RESULTS: Of 101 patients (62 male), 62 (61.39%) received defunctioning loop
      ileostomy. In univariate analysis, male gender and patients with ileostomy showed
      more frequently prolonged paralysis by tendency (both p = 0.07). Logistic
      regression analysis proves the influence of a defunctioning ileostomy on the
      development of prolonged postoperative paralytic ileus after oncologic rectal
      resection (p = 0.047). Odds ratio for prolonged postoperative paralytic ileus in 
      patients with ileostomy was 4.96 [95% CI 1.02-24.03]. CONCLUSIONS: Although the
      construction of defunctioning loop ileostomies during rectal resection is a safe,
      uncomplicated surgical procedure, they can cause significant postoperative
      morbidity for the patients. High fluid and electrolyte loss are well-known
      complications, but herewith we raise the evidence for prolonged gut paralysis in 
      patients with defunctioning loop ileostomy.
FAU - Reichert, Martin
AU  - Reichert M
AD  - Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery,
      University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen,
      Germany. martin.reichert@chiru.med.uni-giessen.de.
FAU - Weber, Christian
AU  - Weber C
AD  - Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery,
      University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen,
      Germany.
FAU - Pons-Kuhnemann, Jorn
AU  - Pons-Kuhnemann J
AD  - Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of
      Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany.
FAU - Hecker, Matthias
AU  - Hecker M
AD  - Department of Pulmonary and Critical Care Medicine, University Hospital of
      Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
FAU - Padberg, Winfried
AU  - Padberg W
AD  - Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery,
      University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen,
      Germany.
FAU - Hecker, Andreas
AU  - Hecker A
AD  - Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery,
      University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen,
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20180815
PL  - Germany
TA  - Int J Colorectal Dis
JT  - International journal of colorectal disease
JID - 8607899
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Body Mass Index
MH  - Cohort Studies
MH  - Digestive System Surgical Procedures/*adverse effects
MH  - Female
MH  - Humans
MH  - *Ileostomy
MH  - Intestinal Pseudo-Obstruction/*etiology
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*etiology
MH  - Rectal Neoplasms/*complications/*surgery
MH  - Risk Factors
OTO - NOTNLM
OT  - Ileostomy
OT  - Ileus
OT  - Oncology
OT  - Paralysis
OT  - Rectal resection
EDAT- 2018/08/17 06:00
MHDA- 2019/01/22 06:00
CRDT- 2018/08/17 06:00
PHST- 2018/08/10 00:00 [accepted]
PHST- 2018/08/17 06:00 [pubmed]
PHST- 2019/01/22 06:00 [medline]
PHST- 2018/08/17 06:00 [entrez]
AID - 10.1007/s00384-018-3142-3 [doi]
AID - 10.1007/s00384-018-3142-3 [pii]
PST - ppublish
SO  - Int J Colorectal Dis. 2018 Nov;33(11):1551-1557. doi: 10.1007/s00384-018-3142-3. 
      Epub 2018 Aug 15.