Application of an enhanced recovery pathway for ileostomy closure: a case-control trial with surprising results.

Détails

ID Serval
serval:BIB_8A3B3C37EC6D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Application of an enhanced recovery pathway for ileostomy closure: a case-control trial with surprising results.
Périodique
Techniques in coloproctology
Auteur(s)
Slieker J., Hübner M., Addor V., Duvoisin C., Demartines N., Hahnloser D.
ISSN
1128-045X (Electronic)
ISSN-L
1123-6337
Statut éditorial
Publié
Date de publication
03/05/2018
Peer-reviewed
Oui
Volume
22
Numéro
4
Pages
295-300
Langue
anglais
Notes
Publication types: Journal Article

Résumé
Enhanced recovery after surgery (ERAS) protocols have been widely validated in colorectal surgery; however, few data exist on loop ileostomy closure. The aim of this study was to compare clinical outcomes before and after introduction of ERAS for loop ileostomy closure.
Data on outcomes after loop ileostomy closure were retrospectively collected before ERAS was applied at our department (control group). These results were compared to results of patients undergoing loop ileostomy closure within the original colorectal ERAS pathway (ERAS 1 group); after analysis of these results, adaptations were made to the ERAS pathway regarding the postoperative diet, and this second category of patients was analyzed (ERAS 2 group).
Forty-eight patients in the control group were compared to 46 ERAS 1 and 69 ERAS 2 patients. First stool was significantly faster in ERAS 2 group versus control and ERAS 1 group [median 1 (range 1-2) days vs 2 (2-3) days p value 0.01]. The incidence of vomiting increased from 26% in the control group to 45% in ERAS 1 group, and then decreased to 29% in the ERAS 2 group (p value 0.41). Length of stay was significantly shorter during the ERAS 2 protocol: median 4 (range 3-6) days versus 5 (4-8) days in the control group (p value < 0.01).
After application of the 'colorectal' ERAS pathway to loop ileostomy closure, results were initially not improved. Minor corrections were sufficient to avoid increased incidence of vomiting and to allow for reduced hospital stay. Uncritical extrapolation of an ERAS colorectal protocol to other types of surgery should be monitored and needs audit for corrections.
Mots-clé
Enhanced recovery after surgery, Ileostomy, Postoperative ileus
Pubmed
Web of science
Création de la notice
12/05/2018 11:20
Dernière modification de la notice
15/06/2018 6:26
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