title: Preoperative perfusion of bypassed ileum does not improve postoperative function.
abstract: This study evaluated whether twice daily isotonic perfusion of the bypassed ileum for six weeks would enhance its motor activity and its absorption of fluids, electrolytes, and vitamin B12. The study also determined if patients undergoing perfusion had improved bowel function and decreased hospital stay after ileostomy closure. Following proctocolectomy, ileal pouch-anal canal anastomosis, and diverting loop ileostomy, six patients self-infused an isotonic solution (sucrose and sodium chloride) into the bypassed ileum twice daily, while seven patients did not (controls). Two months following proctocolectomy, and just prior to ileostomy closure, a manometric catheter assembly was placed into the unused distal ileum via the stoma and the distal ileum perfused with an isotonic sodium chloride solution for 3 hr during fasting and 3 hr after a meal. Absorption was measured, single and clustered pressure waves were identified, and a motility index was calculated. Water absorption, motility index, and cluster parameters did not improve in perfused patients compared to controls during fasting or after a meal, nor did perfused patients have improved vitamin B12 absorption. The perfused patients also did no better clinically following ileostomy takedown; the onset of bowel movements, their frequency, time to tolerate a diet, and hospital stay were similar to controls. We conclude that six weeks of twice daily isotonic perfusion did not improve motor activity or water, electrolyte, and vitamin B12 absorption in the bypassed distal ileum after proctocolectomy, ileal pouch-anal canal anastomosis, and loop ileostomy. The perfusion also did not improve bowel function after ileostomy takedown.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Miedema
authors.forename: L
authors.initials: L
authors.lastname: Köhler
authors.forename: C D
authors.initials: CD
authors.lastname: Smith
authors.forename: S F
authors.initials: SF
authors.lastname: Phillips
authors.forename: K A
authors.initials: KA
authors.lastname: Kelly
mesh_terms: D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000187:drug effects / Q000502:physiology*; D007408:Intestinal Absorption / Q000187:drug effects; D007552:Isotonic Solutions / Q000494:pharmacology; D008297:Male; D010477:Perfusion; D011184:Postoperative Period; D011300:Preoperative Care; D016737:Proctocolectomy, Restorative
chemical_list: D007552:Isotonic Solutions