Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction

Xiaowei Wang; Yizhi Wang; Beibei Lin; Yue Liu; Jin Gu; Limian Ling; Dong Xu; Kefeng Ding

doi:10.3389/fonc.2023.1187858

Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction

Front Oncol. 2023 Jul 31:13:1187858. doi: 10.3389/fonc.2023.1187858. eCollection 2023.

Authors

Xiaowei Wang¹, Yizhi Wang², Beibei Lin³, Yue Liu³, Jin Gu², Limian Ling³, Dong Xu³, Kefeng Ding³

Affiliations

¹ Department of Anorectal Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China.
² Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
³ Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

Abstract

Background: Stoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction.

Methods: A single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 1^st July 2022 to 31^st December 2022. The stoma pressure was measured by TISM at different time points.

Results: The mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmH₂O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH₂O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function) (10.23 vs. 6.04 cmH₂O, p<0.001) and the postoperative hospital stay (10 vs. 8.49 days, p=0.028) showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) (4 vs. 4.49 cmH₂O, p=0.585), the second time point (the day of return of gut function) (6.8 vs. 5.62 cmH₂O, p=0.123), and the fourth time point (discharge day) (5.88 vs. 5.9 cmH₂O, p=0.933) showed no significant difference in both groups.

Conclusion: TISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS.

Keywords: eras; ileostomy; manometry; rectal cancer; stoma outlet obstruction.

Grants and funding

This work was funded by Science and Technology Project of Wenling (2019S180067) and (2019S180071).