Effectiveness of Efferent Loop Stimulation Prior to Protective Ileostomy Closure Short

Introduction: Postoperative ileus after an ileostomy closure is the most frequent complication and involves a significant increase in morbidity, hospital stay and costs. Our aim was to define the effect of stimulation of the efferent loop before the closure of the ileostomy in those terms.

Methods: Prospective and comparative study of a consecutive 45 cases subjected to an ileostomy closure with a previous stimulation of the distal end loop (SEL), compared to a cohort of 40 unstimulated historical controls (NSEL). Time to oral tolerance, reappereance of bowel movements, postoperative ileus and hospital stay were compared.

Results: Both groups were homogeneous in age, sex, BMI, ASA, previous surgeries, complications after the first intervention, and interval until the ileostomy closure. The SEL group had an earlier return to oral tolerance (2.8 ± 1.1 vs 6 ± 4.4 days, p <0.001) and passage of flatus (2.17 ± 0.88 vs 3.29 ± 1, 99 days, p = 0.002). Postoperative ileus and hospital stay were lower in SEL (20% vs 41.5%, p = 0.03 and 3.7 ± 0.99 vs 7.7 ± 4 days, p <0.001 respectively). It seems there is a tendency to decrease the postoperative ileus depending on the days of stimulation, though it did not reach statistical significance.

Discussion: Our main limitation is the non-randomized set up, which might impair external validity.

Conclusion: Stimulation of the efferent loop before the ileostomy closure is a safe technique and reduces postoperative ileus and hospital stay, while allowing earlier oral tolerance and restitution of bowel functions.

Keywords: Efferent Loop Stimulation, Postoperative ileus.