Bowel Rest with Total Parenteral Nutrition as an Alternative to Diverting Ileostomy in High-Risk Colorectal Anastomosis: A Pilot Study

Anastomotic leakage remains the most feared complication in colorectal surgery. Various intraoperative tests evaluate bowel perfusion and mechanical integrity of the colorectal anastomosis. These tests reduce the risk of postoperative anastomotic leakage; however, the incidence remains high. Diverti...

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Bibliographic Details
Published in:Medicina (Kaunas, Lithuania) Lithuania), 2022-04, Vol.58 (4), p.510
Main Authors: Kryzauskas, Marius, Jakubauskas, Matas, Gendvilaite, Neda, Rudaitis, Vilius, Poskus, Tomas
Format: Article
Language:English
Subjects:
Anastomosis, Surgical - adverse effects
Anastomotic Leak - etiology
Anastomotic Leak - prevention & control
anastomotic leakage
Body mass index
bowel rest
Brief Report
Clinical trials
Colorectal cancer
Colorectal Neoplasms
Colorectal surgery
Humans
Ileostomy - adverse effects
Laparoscopy
Morbidity
Nutrition
Obesity
Ostomy
Parenteral nutrition
Parenteral Nutrition, Total
Patients
Pilot Projects
Quality of Life
Recovery (Medical)
Rectum
Retrospective Studies
Surgeons
Surgical anastomosis
total parenteral nutrition
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Summary:Anastomotic leakage remains the most feared complication in colorectal surgery. Various intraoperative tests evaluate bowel perfusion and mechanical integrity of the colorectal anastomosis. These tests reduce the risk of postoperative anastomotic leakage; however, the incidence remains high. Diverting loop ileostomy mitigates the damage if anastomotic leakage occurs. Nevertheless, ileostomy has a significant rate of complications, reducing patients' quality of life, and requiring an additional operation. We evaluated six consecutive cases where bowel rest with total parenteral nutrition was used instead of diverting loop ileostomy. All colorectal anastomoses were at high risk of postoperative anastomotic leakage. Total parenteral nutrition was administered for the first seven days postoperatively. There were no serious complications during the recovery period, and no clinical postoperative anastomotic leakage was detected. All patients tolerated total parenteral nutrition. Bowel rest with total parenteral nutrition may be a feasible option in high-risk left-sided colorectal anastomosis and a possible alternative to a preventive loop ileostomy. Further studies are necessary to evaluate it on a larger scale.
ISSN:1648-9144
1010-660X
1648-9144
DOI:10.3390/medicina58040510