ABSTRACT
Background: Diversion colitis is a non-specific inflammation of a defunctionalised segment of the colon after a temporary stoma has been performed. This inflammation is associated with a change in the colonic flora. Aim: To evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to closure of the protective ileostomy in patients operated on colorectal carcinoma and its effect on diversion colitis. A prospective, randomised, double-blind, controlled study is carried out. Methods: Patients who underwent surgery for colorectal carcinoma with protective ileostomy pending reconstructive surgery and with diversion colitis as diagnosis are included. Randomised and divided into two groups. Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery. Results: Patients in CG were distributed according to the endoscopic index of severity in pre-stimulation/post-stimulation as follows: severe n = 9/9 (25.7%), moderate n = 23/23 (65.7%), and mild n = 3/3 (8.6%); compared to the distribution in SG, severe n = 9/0 (26.5/0%), moderate n = 23/3 (67.6/8.8%), mild n = 2/19 (5.9/55.9%) and normal colonoscopy in 0/12 patients (0/35.3%). Conclusion: Probiotic stimulation of the efferent loop is a safe and effective method, managing to reduce both macroscopic and microscopic colitis, as well as a decrease in symptoms in the short term after reconstructive surgery.
ABSTRACT
The use of a loop ileostomy as the defunctioning procedure of choice to protect a distal colonic anastomosis causes histological and endoscopic changes in the intestinal mucosal architecture, which have been related to chronic inflammation and changes in the microflora that consequently impact the intestinal structure and function following fecal stream diversion. The aim of this study was to evaluate the histological and endoscopic changes on the colonic mucosa in patients with diversion colitis after stimulation of the efferent loop with probiotics prior to closure of the protective ileostomy. A prospective, randomized, double-blind, controlled study was designed. All patients who underwent surgery for colorectal carcinoma with protective ileostomy between January 2017 and December 2018 were included. These patients were pending reconstructive surgery and were diagnosed with endoscopic and histological diversion colitis. Divided into two groups, a group stimulated with probiotics (SG) and a control group (CG). 34 cases and 35 controls were included in the study. Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery. A decrease in endoscopic pathological findings (mucosal friability, mucous erosions, polyps, edema, erythema and stenosis) and in histological findings (follicular hyperplasia, eosinophils, cryptic abscesses, lymphocyte infiltration, plasma cell infiltration and architecture distortion) was observed in SG. These results were statistically significant with a p < 0.001. The stimulation of the efferent loop of the ileostomy in patients with diversion colitis produced a decrease of the endoscopic and histological severity of colitis in the short term.
ABSTRACT
Chyle fistula is an infrequent complication after neck surgery. The first line treatment is medical management, with adequate drainage and appropriate nutritional modifications. The use of octreotide in the treatment of chyle fistula is a novel approach that has been documented in only a few cases. We report a new case of thoracic duct injury effectively treated by octreotide, leading to an early decrease in drainage and early fistula closure with minimal adverse effects. This therapy may reduce length of hospital stay and morbidity. Further studies are required to confirm this observation.
Subject(s)
Chyle , Fistula/drug therapy , Gastrointestinal Agents/therapeutic use , Intraoperative Complications/drug therapy , Octreotide/therapeutic use , Postoperative Complications/drug therapy , Thoracic Duct/injuries , Aged , Female , HumansABSTRACT
La fístula del conducto torácico en una complicación poco frecuente tras la cirugía cervical. El primer escalón terapéutico es el tratamiento médico, con un adecuado drenaje y mediante medidas dietéticas. El uso de la octreótida en el tratamiento de la fístula quilosa es novedoso, y los casos comunicados son anecdóticos. Aportamos un nuevo caso en que el tratamiento con octreótida fue efectivo en el tratamiento de la lesión del conducto torácico y el cierre temprano de la fístula, con mínimos efectos secundarios. Este tratamiento permite reducir la estancia hospitalaria y la morbilidad del paciente. Creemos necesarios estudios posteriores que confirmen estos hallazgos (AU)
Chyle fistula is an infrequent complication after neck surgery. The first line treatment is medical management, with adequate drainage and appropriate nutritional modifications. The use of octreotide in the treatment of chyle fistula is a novel approach that has been documented in only a few cases. We report a new case of thoracic duct injury effectively treated by octreotide, leading to an early decrease in drainage and early fistula closure with minimal adverse effects. This therapy may reduce length of hospital stay and morbidity. Further studies are required to confirm this observation (AU)
