Effect of Distal Loop Stimulation with Ileostomy Effluent on Return of Bowel Function Post Ileostomy Reversal in Emergency Laparotomy Patients

Context: Postoperative ileus is the most common complication of ileostomy reversal. Aim: The aim is to evaluate the effect of reinfusion of proximal loop effluent into the distal loop of stoma in bowel function recovery in patients with ileostomy. Settings and Design: A prospective nonrandomized interventional study was undertaken in the surgery department of UCMS and GTB hospital, Delhi, from September, 2022, to February, 2024. Materials and Methods: 62 patients were divided into two groups, where the intervention group ( n = 31) received proximal bowel effluent refeeding into the distal loop of stoma daily for 7 days before ileostomy reversal, while the control group ( n = 31) received no refeeding. Postoperative return of bowel function was compared between the two groups. Independent sample “ t ” test was used for continuous data and Chi-squared test for categorical data. Results: Interval to first passage of stool after stoma reversal was significantly shorter in the intervention group as compared to controls (44.6 ± 21.45 h vs. 69.85 ± 37.16 h; P < 0.01). The mean duration of return of bowel sound (17.03 ± 30.21 h vs. 38.6 ± 20.71 h), return of appetite (21.29 ± 24.86 h vs. 40.4 ± 21.41 h; P < 0.01), first passage of flatus (30.38 ± 22.43 h vs. 59.08 ± 28.85 h; P < 0.01) and length of hospital stay (6.1 ± 1.67 days vs. 7.8 ± 1.62 days; P < 0.01) were also significantly shorter in the intervention group. Conclusions: Distal bowel stimulation by ileostomy effluent is beneficial in early recovery of bowel function, return of appetite, and thus leads to shorter hospital stay in patients undergoing ileostomy reversal. Further randomized controlled trials with a larger sample size are required to establish chyme reinfusion as a standard treatment before ileostomy closure.