Chyme Reinfusion in Patients with High-Output Enterocutaneous Fistulas and Enterostomies Undergoing Surgical Reconstruction: A Systematic Literature Review and Meta-Analysis

BACKGROUND: Chyme reinfusion (CR) is a simple technique that reestablishes gastrointestinal continuity. The primary objective was to analyze the pooled evidence of the CR effect on postoperative outcomes following ostomy or fistula repair. METHODS: This meta-analysis was performed according to the current PRISMA guidelines and included all studies that provided postoperative outcome data on CR compared with the control group (no CR) in high-output ostomies and enterocutaneous fistulas. The data from eligible studies were extracted, qualitatively assessed, and included. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. The risk of bias was assessed using the ROBINS-I criteria. RESULTS: Five eligible studies with a total of 460 patients were included (CR: n = 219, control: n = 241). CR demonstrated significantly lower rates of overall complications (OR 0.25, 95% CI 0.13-0.46, p < 0.00001), ileus (OR 0.35, 95% CI 0.22-0.53, p < 0.00001), and diarrhea (OR 0.29, 95% CI 0.12-0.69, p = 0.005). As a result, the hospital stay was significantly reduced after CR as compared to the control group (SMD - 0.76, 95% CI - 1.46 to - 0.07, p = 0.03). In addition, the postoperative inflammatory markers CRP (C-reactive protein) (SMD - 0.76, 95% CI - 0.98 to - 0.53, p < 0.0001) and WBC (white blood count) (SMD - 0.67, 95% CI - 1.09 to - 0.25, p = 0.002) were significantly lower after CR. CONCLUSIONS: CR is a safe and easy-to-use method which leads to a significant reduction in inflammatory response and postoperative complications such as ileus or diarrhea and thus significantly shortens the hospital stay. This method should therefore be considered as an additional supportive procedure for patients with high-output ostomies or fistulas. The further legitimacy and justification of CR should now be verified in multi-center randomized studies.