In selective patients, chyme reinfusion via distal loop ileostomy  reduced anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis

doi:10.21203/rs.3.rs-2953366/v1

Download PDF

Research Article

In selective patients, chyme reinfusion via distal loop ileostomy reduced anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis

https://doi.org/10.21203/rs.3.rs-2953366/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose

This study aimed to investigate effect of chyme reinfusion (CR) via distal loop ileostomy, in selective patients with pancreatitis cure, on the reduction of anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis (SAP)

Methods

From January 2009 to May 2021, patients who were suitable for CR via distal loop ileostomy and underwent excision of colonic fistula following SAP were considered to be eligible. Patients were selected and considered suitable for CR if the following conditions were met: (1) SAP cured; (2) no colon obstruction; (3) colonic fistula drainage tube was in place; and (4) no pus cavity was around the fistula and the sinus mature. Before 2014, CR was not used, whereas it was widely used after 2014 in selected patients. Patients were divided into the CR group and non-CR group according to whether CR was performed. The effect of CR on reduction of postoperative anastomotic leakage were then investigated.

Results

Eighty-five patients were enrolled in the study. There were 40 patients in the non-CR group and 45 patients in the CR group, with a total of 28 (32.9%) patients with anastomotic leakage. CR (OR = 0.48; 95% CI: 0.24–0.95; p = 0.036) reduced the incidence of anastomotic leakage. In addition, CR (HR = 0.51; 95% CI: 0.27–0.86, p = 0.012) was shown to reduce the incidence of postoperative ileus.

Conclusion

In selected patients with pancreatitis cure, CR via distal loop ileostomy for colonic fistula following SAP reduced the anastomotic leakage rate.

Chyme reinfusion

Colonic fistula

Severe acute pancreatitis

Outcomes

anastomotic leakage

Gastrointestinal fistulas are potentially fatal complications that can follow severe acute pancreatitis (SAP), whose incidence varies from 3–47%, according to different studies. Of all gastrointestinal fistulas[1–3], colonic fistulas are the most common, occurring in more than 60% of all gastrointestinal fistulas[4]. Even if fecal diversion is performed, spontaneous closure may not occur in more than half of patients with colonic fistula [4]. In addition, the anastomotic leakage rate can be high following complicated excision of colon fistula[5].

Ileostomy is an effective and simple infection control method for the treatment of colonic fistulas. However, this process may lead to the disuse of the colon, which can further lead to colonic pathological changes[5, 6], aggravate the postoperative inflammation [9], and induce adverse outcomes [10, 11]. Preoperative reconstruction digestive continuity reverses pathological changes following disuse of the digestive tract and improves outcomes after ileostomy closure [8, 10, 11]. Chyme reinfusion (CR) is an effective technique to maintain the continuity of digestive tract, and reduces postoperative anastomotic leakage and defecation time in patients with enteroatmospheric fistula. What's more, the process of placing the CR tube via the distal end of ileostomy is very simple in patients with loop ileostomy following colonic fistula. However, CR via distal ileostomy may lead to a relative deficiency of colonic fistula drainage as well as abdominal infection. In the last six to seven years, CR has been attempted in patients with well source control and colon unobstructed at our centers. The hypothesis is, in selective patients, CR via distal loop ileostomy reduce the postoperative anastomotic leakage after excision for colonic fistula following SAP. Thus, the effect and safety of the preoperative CR were evaluated.

This study was a retrospective cohort study registered in Thai clinical trials registry (TCTR20220117004, https://www.thaiclinicaltrials.org/show/TCTR20220117004). It was performed at two tertiary hospital and was approved by the institutional review board (NJZY-21-0168). This study was reported in line with the STROCSS criteria[12]. All methods were performed in accordance with relevant guidelines and regulations.

2.1. Treatment of SAP

The treatment of SAP was performed under the purview of an experienced professional team in the pancreatitis treatment group at our hospital, where every year, hundreds of patients with SAP are transferred. The treatment of SAP included source control (step up approach), nutrition nutritional support, intensive care, and organ support. There were patients with colonic fistula following SAP, and once diagnosed, loop ileostomy was performed in the pancreatitis treatment group (twenty cm from ileostomy to ileocecus ). Pancreatitis was considered to be cured after symptoms disappeared (no fever, no abdominal distention, and with normal white blood cells). Meanwhile, pancreatic drainage tubes were removed and self-diet was restored. Drainage tube(s) for colonic fistula and loop ileostomy were retained until excision of fistula. At least three months after pancreatitis was cured, patients were admitted to the department of enterocutaneous fistula group for the surgical treatment of colonic fistula. The enterocutaneous fistula group and pancreatitis treatment group belonged to the same hospital.

2.2. Population and grouping

From January 2009 to May 2021, patients receiving excision of colonic fistula following SAP and suitable for CR via distal loop ileostomy were considered to be eligible. The exclusion criteria were: (1) patients younger than 18 years of age; (2) patients who also had upper gastrointestinal fistula, pancreatic fistula, or duodenal fistulas that may influence the difficulty of the operation.

The primary outcome was the incidence of anastomotic leakage. The secondary outcomes included: (1) incidence of postoperative ileus (defecation time > seven days) and (2) gastrointestinal adverse reactions of CR.

2.3. Selected patients suitable for CR

Before 2014, CR was not planned or widely used for treatment. All patients did not receive CR before excision, regardless of whether CR was appropriate. In the last six to seven years, CR has been used in selected patients.

After years of practice using CR, it was revealed that patients should meet the following conditions for CR: (1) SAP cured; (2) no colon obstruction; (3) colonic fistula drainage tube was in place; and (4) no pus cavity around the fistula and the sinus mature (Fig. 1). The corresponding patients were then selected and considered to be suitable for CR using these criteria.

2.4. CR

If CR was initially planned, it was given at least for one month prior to excision. The CR tube was placed under X ray guidance, and a Foley catheter was placed into the distal ileostomy (the end of Foley tube shall be at least 10cm to the ileostomy), whose location was then confirmed by gastroenterography. CR was performed every two to four hours. During this time, the ileostomy fluid was collected and slowly injected into the colon through the CR tube.

2.5. Excision of colonic fistula

During excision, the colonic fistula was locally resected, and ileostomy was closed. Lateral-lateral end anastomosis was performed in each anastomosis using a linear stapler (Pride Medical Inc., Jingjiang, Taizhou, Jiangsu, China). Before anastomosis, the digestive tract was gradually dissociated. In patients with cholecystolithiasis, cholecystectomy was also performed during excision. In addition, there were patients who underwent laparotomy during treatment of SAP. Of those patients, there were some patients who did not undergo primary facial closure and received planned abdominal wall hernia repair. Repair of the abdominal wall hernia was carried out using a Cook Biodesign advanced tissue repair device (Cook Medical Inc., Bloomington, IN, USA) and was performed during DS.

Patients with SAP are in high risk of diabetes, as a result, blood glucose control is important during the perioperative period. Four segments of blood glucose were measured, and the blood glucose was controlled to less than 10 mmol / L within 14 days before excision. The blood glucose was then measured every six hours after DS, where the target keeping blood glucose less than 10 mmol / L until the patient was discharged. Fourteen days after the surgery, a colonography was performed, and the diagnosis of anastomotic leakage was confirmed.

2.6. Data analysis

The baseline data included general patient information (sex, BMI, and age) and laboratory test results, such as haemoglobin, and albumin, which were collected upon admission for excision. The location of the fistula and colonic patency were collected according to the gastroenterographic data (including CT and colonography). The laboratory tests were performed every day within seven days following DS, and the results were collected and used in the subsequent analysis. Stool characteristics during CR or after surgery were collected according to the clinical record. In our study, according to the Bristol stool chart[13], diarrhea was defined to occur in a patient with a stool consistency above type V (V-VII).

All statistical analyses were performed using SPSS 26.0 software (IBM, Analytics, Armonk, NY, USA). A Mann–Whitney U-test was used to compare continuous variables across groups. Fisher’s exact test was used to compare categorical variables. Kaplan–Meier estimates followed by a log-rank test and multivariate logistics and Cox regression analysis were used to compare the effects of different methods. A P value of < 0.05 was considered to be statistically significant.

3.1. Investigation of patients suitable for CR

After chart review, it was revealed that there was a total of 122 patients with a loop ileostomy who underwent excision of colon fistula. Of the 122 patients, 70 patients were treated when CR was widely used. Before CR, CT and colonography were performed to evaluate the fistula and drainage. A total of 15 patients were screened out as unsuitable for CR (six of the 15 patients had colonic fistula drainage tubes fall out, five patients had fistula surrounded by a cavity, and four patients had colon obstruction). In the remaining 55 (78.6%) patients, after CR, nine patients had fever, whose highest body temperature was 38.4℃. Re-examination of angiography and CT showed that the drainage was sufficient, and there was no pus cavity around the fistula. After three to five days of antibiotic treatment, their symptoms disappeared, and CR was performed successfully. According to our standards for CR, all the 55 patients could receive the CR safety.

In the other 52 patients who were treated when CR was not widely used, six (11.5%) patients were found to be unsuitable for CR (three had colon obstruction, one had the drainage tube fall out, and two had fistula surrounded by a cavity). forty-six patients were regard as suitable for CR, and there were six patients with transient fever after CR.

Totally, According to CR standards in the present study, the proportion of patients suitable for CR was 82.8% (101/122). CR could be successfully performed in those patients (Fig. 1).

3.2. Population

There was a total of 101 eligible patients who received excision of colonic fistula following SAP and who were suitable for CR via distal loop ileostomy. Meanwhile, 16 patients (including one patient younger than 18 years old, 14 patients with upper gastrointestinal fistula, pancreatic fistula, or duodenal fistulas, and one patient without complete data) were excluded.

Eighty-five patients were finally enrolled in the study (Fig. 2). There were 40 patients in the non-CR group and 45 patients in the CR group. The characteristics of the two groups are given in Table 1. The median age was 40.0 years (IQR:35.0–44.0 years) in the CR group and 41.0 years (IQR:36.0–46.0 years) in the non-CR group (P = 0.410). There were 14 (31.1%) females in the CR group and 13 (32.5%) in the non-CR group (P = 0.891). All fistulas were diagnosed after surgical intervention for SAP. The fistula occurred seven days after intervention in 60 patients (70.6%, 32 [71.1%] in the CR group vs. 28 [70.0%] in the non-CR group, P = 0.911). No differences in the characteristics between the two groups existed.

Table 1

baseline characteristics
	CR group (n = 45)	None CR group (n = 40)	p
Female,No.(%)	14 (31.1)	13(32.5)	0.891
Age, year;(median,IQR )	40.0(35.0–44.0)	41.0(36.0–46.0)	0.410
Preoperative BMI, kg/m2,(mean ± SD )	23.4 ± 2.0	23.2 ± 1.7	0.602
Etiology of SAP,No.(%)			0.880
Cholelithiasis	17(37.8)	17(42.5)
Hyperlipidemic	25(55.5)	21(52.5)
Alcoholic	3(6.7)	2(5.0)
Location of fistula ,No.(%)			0.905
Transverse colon	18(40.0)	15(37.5)
Splenic flexure	24(53.3)	23(57.5)
Descending colon	3(6.7)	2(5.0)
Timing of fistula occurrence ,No.(%)			0.911
Seven days after intervention for SAP	32(71.1)	28(70.0)
Within seven days of intervention for SAP	13(28.9)	12(30.0)
Receiving laparotomy during SAP treatment,No.(%)	22(48.9)	16(40.0)	0.411
Hernia repair during excision,No.(%)	12(26.7)	9(22.5)	0.802
Interval from SAP diagnosed to fistula occurrence, days, (median,IQR)	49(36–79)	51(43–81)	0.177
Interval from fistula occurred to definitive surgery, months, (median,IQR)	3.0(3.0–4.0)	3.0(3.0–4.0)	0.755
Preoperative albumin, g/L,(median,IQR)	39.5(37-41.3)	39.2(36.1–41.4)	0.818
Preoperative hemoglobin, g/L,(median,IQR)	129(122–136)	130(123–137)	0.473
Blood loss during definitive surgery, ml, (median,IQR)	1600(1400–1900)	1700(1400–2000)	0.307
Duration of definitive surgery, min, .(median,IQR)	210(170–240)	210(180–240)	0.341
With cholecystectomy during DS,No. (%)	18(40)	17(42.5)	0.815
The amount of red blood cells infused during and within48 hours after excision*,Unit, .(median,IQR)	6(4–6)	6(4–6)	0.598
The amount of red blood cells infused during and within48 hours after excision**, g.(median,IQR)	80(40–120)	80(60–120)	0.299
Comorbidity,No.(%)
Hypertension	4(8.9)	3(7.5)	1.000
Impaired glucose tolerance	20(44.4)	23(57.5)	0.280
Chronic hepatitis	1(2.2)	1(2.5)	1.000
*In order to maintain the Hemoglobin > 100 g/L within 48 hours after surgery
**In order to maintain the Albumin > 30 g/L within 48 hours after surgery

3.3. Primary outcome

There was a total of 28 patients with colonic anastomotic leakage, for which the overall incidence was 32.9%, while ileal anastomotic leakage following ileostomy closure was not detected. The incidence of anastomotic leakage was 22.2% (10/45) in the CR group, and 45.0% (18/40) in the non-CR group. The unadjusted (OR = 0.35; 95% CI:0.13–0.89; P = 0.028) and adjusted (OR = 0.48; 95% CI:0.24–0.952; P = 0.036) logistics regression showed that CR reduced the incidence. In addition, receiving a laparotomy for SAP to control infection (adjusted OR = 2.05; 95% CI: 1.05–3.98; P = 0.034) was found to be a associated factor (Tables 2 and 3). Otherwise the additional operations during DS including cholecystectomy and hernia repair was not associated with the leakage (Table 2). Of the 28 patients with anastomotic leakage, only three patients received puncture and drainage due to abdominal infection, and no patients received re-laparotomy. In addition, of the 57 patients without postoperative abdominal infection, the WBC and CRP was noted to be lower in the CR group on the 3rd and 7th days after DS (Figs. 3A and 3B).

Table 2

Unadjusted logistics regression for the leakage
	OR	95%CI	p
Female	0.468	0.163–1.337	0.156
CR	0.349	0.137–0.893	0.028
Age	1.006	0.965–1.048	0.791
Preoperative BMI	0.973	0.818–1.157	0.757
Etiology of SAP
Cholelithiasis	Ref
Hyperlipidemic	0.897	0.350–2.297	0.820
Alcoholic	0.469	0.048–4.554	0.514
Location of fistula
Transverse colon	Ref
Splenic flexure	1.187	0.456–3.090	0.725
Descending colon	1.533	0.221–10.639	0.665
Timing of fistula occurrence
seven days after intervention for SAP	Ref
Within seven days of intervention for SAP	0.689	0.242–1.964	0.486
Receiving laparotomy during SAP treatment	2.649	1.045–6.715	0.040
Hernia repair during excision	2.323	0.842–6.411	0.104
Interval from SAP diagnosed to fistula occurrence	1.022	0.658–2.694	0.518
Interval from fistula occurred to definitive surgery	0.795	0.214–1.594	0.211
Preoperative albumin	0.959	0.835-1.100	0.548
Preoperative hemoglobin	0.969	0.930–1.009	0.122
Blood loss during definitive surgery	1.001	1.000-1.002	0.014
Duration of definitive surgery	1.001	0.989–1.019	0.668
With cholecystectomy during DS	1.109	0.443–2.773	0.825
The amount of red blood cells infused during and within48 hours after excision*	1.089	0.950–1.248	0.221
The amount of red blood cells infused during and within48 hours after excision**	1.041	1.025–1.057	< 0.001
Comorbidity
Hypertension	0.315	0.036–2.751	0.296
Impaired glucose tolerance	2.304	0.906–5.859	0.080
Chronic hepatitis	2.074	0.125–34.436	0.611
*In order to maintain the Hemoglobin > 100 g/L within 48 hours after surgery
**In order to maintain the Albumin > 30 g/L within 48 hours after surgery

Table 3

Adjusted logistics regression for anastomotic leakage
	OR	95%CI	p
Receiving laparotomy during SAP treatment	2.051	1.056–3.984	0.034
Blood loss during definitive surgery	1.001	1.000-1.002	0.089
The amount of red blood cells infused during and within48 hours after excision**	1.001	0.987–1.015	0.892
CR	0.482	0.244–0.952	0.036
**In order to maintain the Albumin > 30 g/L within 48 hours after surgery

3.4. Secondary outcomes

The defecation time was eight days (IOR = 6–9 days) in the non-CR group and six days (IRQ = 5–8 days) in the CR group. Moreover, there were a total of 41 patients with postoperative ileus (defecation time more than seven days). Of the 41 patients, there were 17 patients (37.8%) in the CR group and 24 patients (60.0%) in the non-CR group. The unadjusted (HR = 0.45; 95% CI: 0.28–0.97, P = 0.040) and adjusted (HR = 0.51; 95% CI: 0.27–0.86, p = 0.012) cox-regression showed that CR could reduce the incidence of postoperative ileus (Fig. 4 and Table 4).

Table 4

Adjusted cox regression for postoperative ileus
	HR	95%CI	p
Receiving laparotomy during SAP treatment	0.568	0.324–1.028	0.072
The amount of red blood cells infused during and within48 hours after excision**	1.002	0.995–1.009	0.611
CR	0.509	0.271–0.863	0.012
**In order to maintain the Albumin > 30 g/L within 48 hours after surgery

After postoperative defecation, three patients had diarrhea in the non-CR group. One of the three patients had bloody stools as well, after which the patient was diagnosed with recurrent fistula. No patient in the CR group had postoperative diarrhea after defecation.

Chyme was completely reinfused within one week of initiation of preoperative CR in 40 patients. Five (11.1%) of the 45 patients who could not adapt to CR within a week were considered to have gastrointestinal adverse reactions, such as diarrhea and abdominal distention, including, twopatients with diarrhea, and three with distention. Accordingly, the adopted treatment strategy for complications was appropriate dilution of chyme while slowly recovering its entire amount. CR was completely reinfused within two weeks in the five patients.

Complicated excision of colonic fistula is not an easy process. In a previous study, the incidence of anastomotic leakage was shown to be about 30%[11]. In patients with colonic fistula following SAP, corrosion and contracture of mesocolon also occurred[14]. This pathological change may result in the relative ischemia of colonic anastomosis, which is regarded as a risk factor for anastomotic leakage[15]. In theory, in addition to anatomical changes and severe adhesion caused by retroperitoneal tissue necrosis, patients with colonic fistula following SAP may have a higher risk of postoperative anastomotic leakage.

The present study was the first to evaluate the feasibility and effect of chyme reinfusion in patients with loop ileostomy for colonic fistula following severe acute pancreatitis on outcomes after excision of colonic fistula. Evidently, despite having patients with colonic obstruction (n = 4), drainage tubes falling off (n = 6) and a cavity around the fistula (n = 5) in recurrent years where CR was widely used, 55 of the 70 patients were scheduled for CR, which was successful in all 55 patients (100%). In other words, CR via loop ileostomy for colonic fistula was noted to be feasible following infection control and sufficient drainage.

In this study, the drainage tube for colonic fistula was retained even after treatment for SAP was completed. What requires attention is that even if the diversion (loop ileostomy) is carried out, it may be possible that a small amount of intestinal fluid can enter the colon via distal end of the ileostomy. During the 3-month interval from getting rid of SAP to the treatment of colonic fistula, the drainage tube fell off in seven patients, and recurrent sinus rupture occurred in six of the seven patients (85.71%), demonstrating that the infection source was always present.

Evidently, the anastomotic leakage rate was found to be lower in the CR group (22.2% vs. 45.0%). In addition, the inflammatory indexes after excision were also investigated, and it was confirmed that the CRP and WBC were lower on the 7th day after excision despite being comparable when the surgery was immediately finished. These phenomena seemed to be in line with the findings of previous studies [11, 16] in that the incidence of postoperative anastomotic leakage and postoperative ileus were associated with postoperative inflammation.

Excision of colonic fistula following SAP was noted to be very difficult, which was associated with extensive bleeding, difficult anatomy, huge surgical trauma and inflammatory attack. Necrosis factor -α released by mast cells under the condition of high inflammation will inhibit the movement of the gastrointestinal tract and the wound healing process after intestinal anastomosis [17], thus increasing the risk of anastomotic leakage and prolonging defecation time. In addition, the invasion of neutrophils can directly damage smooth muscle [18, 19], and the imbalance of polarized macrophages can affect collagen deposition and tissue repair, leading to anastomotic leakage occurrence [20, 21]. In patients with disused digestive tract, the pathological changes of digestive tract following the disuse may aggravate the postoperative inflammation after complicated excision of enterocutaneous fistula[22], which would be followed by high incidence of complications. Reversing the pathological changes is the key point to improve postoperative outcomes [4, 5, 8]. Furthermore, in current study, the peristalsis of the colonic smooth muscle will be stimulated by chyme after CR. This effect may make the smooth muscle get proper exercise and make the colon stronger, and the most direct effect would lead to the colon anastomosis easier to be performed and the patency of the anastomosis better guaranteed. Therefore, these factors work together and reduce the incidence of anastomotic leakage and defecation time.

However, laparotomy for SAP in controlling infections was found to be associated with poor outcomes following excision. This did not seem peculiar as patients requiring laparotomy may have serious disease progression and a more pessimistic intra-abdominal situation[23], signifying that the anatomy was more difficult to distinguish, adhesions were more serious, and trauma was greater when excision was.

This study has certain limitations. First, this was a retrospective study; therefore, selection bias was likely present. Second, the sample size of this study was small; however, the colonic fistula following SAP was not a common disease, and to our knowledge, this study had the largest relevant sample size. The third limitation was that mechanisms of the advantages of CR for prognosis were not fully explored. Accordingly, future animal experiments or RCTs should be performed so as to elucidate this matter. Furthermore, the follow-up time was insufficient, and the incidence of leakage was potentially biased. That is to say, some leakage may not become apparent until a certain point after discharge from hospital. As a result, the recurrent rate may have been reported to be falsely lower. However, in our study, a colonography was performed to diagnose the anastomotic leakage. As a result, delayed leakage after discharge should be rare in our study.

In selected patients, CR via distal ileostomy prior to excision of colonic fistula following severe acute pancreatitis is feasible and reduces the postoperative anastomotic leakage.

BMI = Body mass index

CRP = C-reactive protein

CR = Chyme reinfusion

IQR = Interquartile range

SAP = Severe acute pancreatiti

Conflict of interest statement:None

Data statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request

Ethics approval and consent to participate: The protocol for this research project has been approved by Committee of Jinling Hospital and Committee of Jinling Hospital. All methods were carried out in accordance with relevant guidelines and regulations.

Informed consent: Informed consent was obtained by all individuals participating in the study.

Consent for publication: Not applicable.

Availability of data and materials: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Competing interests: The authors declare that they have no competing interests.

Funding statement: No funding was received

Authors' contributions: Risheng Zhao, Fan Yang, Weiliang Tian provide research objects. Xin Xu, Shikun Luo and Risheng Zhao collected and analysed the data; Shikun Luo and Ke Chen wrote the main manuscript text; Xin Xu, prepared figures and revised the manuscript. Zheng Yao and Gguoping Zhao designed the research. Xin Xu reviewed and revised the manuscript. Shikun Luo, Ke Chen and Xin Xu were the first authors. Risheng Zhao, Zheng Yao and Gguoping Zhao were the corresponding authors.

Acknowledgements: Not applicable.

Ho HS, Frey CF. Gastrointestinal and pancreatic complications associated with severe pancreatitis. Arch Surg. 1995;130(8):817-823.
Doberneck RC. Intestinal fistula complicating necrotizing pancreatitis. Am J Surg. 1989;158(6):581-584.
Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg. 1995;130(1):48-52.
Weréen A, Dahlberg M, Heinius G, et al. Long-Term Results after Anastomotic Leakage following Rectal Cancer Surgery: A Comparison of Treatment with Endo-Sponge and Transanal Irrigation. Dig Surg. 2020;37(6):456-462.
Tian W, Xu X, Yao Z, et al. Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery [published online ahead of print, 2020 Sep 25]. World J Surg. 2020;10.1007/s00268-020-05787-6.
Duan M, Cao L, Gao L, Gong J, Li Y, Zhu W. Chyme Reinfusion Is Associated with Lower Rate of Postoperative Ileus in Crohn's Disease Patients After Stoma Closure. Dig Dis Sci. 2020;65(1):243-249.
Danielsen AK, Park J, Jansen JE, et al. Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg.
Bhat S, Sharma P, Cameron NR, Bissett IP, O'Grady G. Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review. Nutr Clin Pract. 2020;35(2):254-264.
Keane C, Park J, Öberg S, et al. Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg. 2019;106(5):645-652.
Abrisqueta J, Abellan I, Luján J, Hernández Q, Parrilla P. Stimulation of the efferent limb before ileostomy closure: a randomized clinical trial. Dis Colon Rectum. 2014;57(12):1391-1396.
Tian W, Xu X, Yao Z, et al. Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery [published online ahead of print, 2020 Sep 25]. World J Surg. 2020;10.1007/s00268-020-05787-6.
O’Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 1990;300:439–40
Aldridge MC, Francis ND, Glazer G, Dudley HA. Colonic complications of severe acute pancreatitis. Br J Surg. 1989;76(4):362-367.
Yang F, Liu D, Xu X, et al. A double-lumen irrigation-suction tube placed during operation could reduce the risk of grade C anastomotic leakage resulting from selective sigmoid colon cancer radical resection. Langenbecks Arch Surg. 2020;405(7):1007-1016.
Boelens PG, Heesakkers FF, Luyer MD, et al. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg. 2014;259(4):649-655.
Ishimura K, Moroguchi A, Okano K, Maeba T, Maeta H. Local expression of tumor necrosis factor-alpha and interleukin-10 on wound healing of intestinal anastomosis during endotoxemia in mice. J Surg Res. 2002;108(1):91-97.
Boeckxstaens GE, de Jonge WJ. Neuroimmune mechanisms in postoperative ileus [published correction appears in Gut. 2010 Jan;59(1):140]. Gut. 2009;58(9):1300-1311.
Lubbers T, Buurman W, Luyer M. Controlling postoperative ileus by vagal activation. World J Gastroenterol. 2010;16(14):1683-1687.
Shi J, Wu Z, Li Z, Ji J. Roles of Macrophage Subtypes in Bowel Anastomotic Healing and Anastomotic Leakage. J Immunol Res. 2018;2018:6827237. Published 2018 Feb 18.
Lubbers T, Buurman W, Luyer M. Controlling postoperative ileus by vagal activation. World J Gastroenterol. 2010;16(14):1683-1687.
Fay KT, Ford ML, Coopersmith CM. The intestinal microenvironment in sepsis. Biochim Biophys Acta Mol Basis Dis. 2017;1863(10 Pt B):2574-2583.
Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27. Published 2019 Jun 13.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

In selective patients, chyme reinfusion via distal loop ileostomy reduced anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis

Status:

Version 1

Abstract

Purpose

Methods

Results

Conclusion

Figures

1. Introduction

2. Materials and Methods

2.1. Treatment of SAP

2.2. Population and grouping

2.3. Selected patients suitable for CR

2.4. CR

2.5. Excision of colonic fistula

2.6. Data analysis

3. Results

3.1. Investigation of patients suitable for CR

3.2. Population

3.3. Primary outcome

3.4. Secondary outcomes

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1