Efferent limb stimulation prior to loop ileostomy closure: a systematic review and meta-analysis,Techniques in Coloproctology

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Efferent limb stimulation prior to loop ileostomy closure: a systematic review and meta-analysis
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2023-12-14 , DOI: 10.1007/s10151-023-02875-2
A J Lloyd _{1,

2} , N P Hardy ₁ , P Jordan ₁ , E J Ryan ₁ , M Whelan ₁ , C Clancy ₁ , J O'Riordan ₁ , D O Kavanagh _{1,

3} , P Neary ₁ , S M Sahebally ₁

Affiliation

Background

Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. Our aim was to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced POI incidence.

Methods

A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases was performed. The last search was carried out on 30 January 2023. All randomized studies comparing PPS versus no stimulation were included. The primary endpoint was POI incidence. Secondary endpoints included the time to first passage of flatus/stool, time to resume oral diet, need for nasogastric tube (NGT) placement postoperatively, length of stay (LOS) and other complications. Random effects models were used to calculate pooled effect size estimates. Trial sequential analyses (TSA) were also performed.

Results

Three randomized studies capturing 235 patients (116 PPS, 119 no stimulation) were included. On random effects analysis, PPS was associated with a quicker time to resume oral diet (MD − 1.47 days, 95% CI − 2.75 to − 0.19, p = 0.02), shorter LOS (MD − 1.47 days, 95% CI − 2.47 to − 0.46, p = 0.004) (MD − 1.41 days, 95% CI − 2.32 to − 0.50, p = 0.002, I2 = 56%) and fewer other complications (OR 0.42, 95% CI 0.18 to 1.01, p = 0.05). However, there was no difference in POI incidence (OR 0.35, 95% CI 0.10 to 1.21, p = 0.10), the requirement for NGT placement (OR 0.50, 95% CI 0.21 to 1.20, p = 0.12) or time to first passage of flatus/stool (MD − 0.60 days, 95% CI − 1.95 to 0.76, p = 0.39). TSA revealed imprecise estimates for all outcomes (except LOS) and further studies are warranted to meet the required information threshold.

Conclusions

PPS prior to stoma closure may reduce LOS and postoperative complications albeit without a demonstrable beneficial effect on POI. Further high-powered studies are required to confirm or refute these findings.

中文翻译：

回肠袢造口闭合前的传出肢刺激：系统评价和荟萃分析

背景

术后肠梗阻（POI）仍然是回肠袢造口闭合术后的常见现象。我们的目的是确定术前传出肢生理刺激 (PPS) 是否可以降低 POI 发生率。

方法

执行了符合 PRISMA 标准的荟萃分析，搜索 PubMed、EMBASE 和 CENTRAL 数据库。最后一次检索于 2023 年 1 月 30 日进行。所有比较 PPS 与无刺激的随机研究均被纳入。主要终点是 POI 发生率。次要终点包括首次排气/大便的时间、恢复口服饮食的时间、术后是否需要放置鼻胃管（NGT）、住院时间（LOS）和其他并发症。使用随机效应模型来计算汇总效应大小估计值。还进行了试验序贯分析（TSA）。

结果

纳入了三项随机研究，纳入了 235 名患者（116 名 PPS，119 名无刺激）。在随机效应分析中，PPS 与恢复口服饮食的更快时间（MD − 1.47 天，95% CI − 2.75 至 − 0.19， p = 0.02）、较短的 LOS（MD − 1.47 天，95% CI − 2.47 至− 0.46， p = 0.004）（MD − 1.41 天，95% CI − 2.32 至 − 0.50， p = 0.002，I2 = 56%），其他并发症较少（OR 0.42，95% CI 0.18 至 1.01， p = 0.05）。然而，POI 发生率（OR 0.35，95% CI 0.10 至 1.21， p = 0.10）、NGT 放置要求（OR 0.50，95% CI 0.21 至 1.20， p = 0.12）或首次传代时间没有差异。肠胃气/粪便（MD − 0.60 天，95% CI − 1.95 至 0.76， p = 0.39）。 TSA 揭示了对所有结果（LOS 除外）的不精确估计，需要进一步研究以满足所需的信息阈值。