Colonic transit

What is the impact of a diverting loop ileostomy?

Sean Huang, Mary Theophilus, Jiamei J. Cui, Stephen W. Bell, Roger Wale, Martin Chin, Chip Farmer, Satish K Warrier

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

Background: Diverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra-low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context. Methods: A prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X-rays were performed at days 1, 3, 5 and 14 post-operation with data collected prospectively. Results: Ten patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1-3). There was no movement in the majority of markers in all patients at Day 5 post-operation. In all seven patients with Day 14 X-rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients. Conclusions: This is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.

Original languageEnglish
Pages (from-to)795-799
Number of pages5
JournalANZ Journal of Surgery
Volume87
Issue number10
DOIs
Publication statusPublished - Oct 2017
Externally publishedYes

Keywords

  • Cathartics
  • Gastrointestinal transit
  • Ileostomy
  • Rectal neoplasms

Cite this

Huang, S., Theophilus, M., Cui, J. J., Bell, S. W., Wale, R., Chin, M., ... Warrier, S. K. (2017). Colonic transit: What is the impact of a diverting loop ileostomy? ANZ Journal of Surgery, 87(10), 795-799. https://doi.org/10.1111/ans.13376
Huang, Sean ; Theophilus, Mary ; Cui, Jiamei J. ; Bell, Stephen W. ; Wale, Roger ; Chin, Martin ; Farmer, Chip ; Warrier, Satish K. / Colonic transit : What is the impact of a diverting loop ileostomy?. In: ANZ Journal of Surgery. 2017 ; Vol. 87, No. 10. pp. 795-799.
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abstract = "Background: Diverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra-low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context. Methods: A prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X-rays were performed at days 1, 3, 5 and 14 post-operation with data collected prospectively. Results: Ten patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1-3). There was no movement in the majority of markers in all patients at Day 5 post-operation. In all seven patients with Day 14 X-rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients. Conclusions: This is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.",
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Huang, S, Theophilus, M, Cui, JJ, Bell, SW, Wale, R, Chin, M, Farmer, C & Warrier, SK 2017, 'Colonic transit: What is the impact of a diverting loop ileostomy?', ANZ Journal of Surgery, vol. 87, no. 10, pp. 795-799. https://doi.org/10.1111/ans.13376

Colonic transit : What is the impact of a diverting loop ileostomy? / Huang, Sean; Theophilus, Mary; Cui, Jiamei J.; Bell, Stephen W.; Wale, Roger; Chin, Martin; Farmer, Chip; Warrier, Satish K.

In: ANZ Journal of Surgery, Vol. 87, No. 10, 10.2017, p. 795-799.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Colonic transit

T2 - What is the impact of a diverting loop ileostomy?

AU - Huang, Sean

AU - Theophilus, Mary

AU - Cui, Jiamei J.

AU - Bell, Stephen W.

AU - Wale, Roger

AU - Chin, Martin

AU - Farmer, Chip

AU - Warrier, Satish K

PY - 2017/10

Y1 - 2017/10

N2 - Background: Diverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra-low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context. Methods: A prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X-rays were performed at days 1, 3, 5 and 14 post-operation with data collected prospectively. Results: Ten patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1-3). There was no movement in the majority of markers in all patients at Day 5 post-operation. In all seven patients with Day 14 X-rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients. Conclusions: This is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.

AB - Background: Diverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra-low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context. Methods: A prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X-rays were performed at days 1, 3, 5 and 14 post-operation with data collected prospectively. Results: Ten patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1-3). There was no movement in the majority of markers in all patients at Day 5 post-operation. In all seven patients with Day 14 X-rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients. Conclusions: This is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.

KW - Cathartics

KW - Gastrointestinal transit

KW - Ileostomy

KW - Rectal neoplasms

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U2 - 10.1111/ans.13376

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