Authors (including presenting author) :
Ng KY (1), Poon CM (1)
Affiliation :
(1) Department of Surgery, Tuen Mun Hospital
Introduction :
Loop ileostomy is essential for fecal diversion after radical surgery of rectal tumour due to its high risk of anastomotic leakage. Yet, loop ileostomy carries a number of morbidities. In particular, high output ileostomy leads to dehydration, electrolyte disturbance or nutritional loss, which may jeopardize postoperative recovery and delay subsequent adjuvant therapy of rectal tumour.
Objectives :
This program aims to (1) provide prophylactic measures to prevent high output ileostomy; (2) early detect high output patients with potential risk of acute kidney injury.
Methodology :
Patients with loop ileostomy after elective rectal cancer surgery were recruited into the program from August 2019 to October 2021. Multidisciplinary approach from doctors, colorectal nurses, stoma nurses and dietitians was adopted to provide patients with stoma output monitoring education, dietary advice and prophylactic medications (loperamide & oral rehydration solution) to avoid high stomal output and subsequent dehydration. Their demographic data, preoperative chemotherapy, pre-existing diabetes, operative details, renal function tests (preoperative, on discharge, on the first follow-up), regular use of loperamide and unplanned admission were all documented. The outcomes included incidence of acute kidney injury (defined by ≥1.5 times increase in serum creatinine from baseline by KDIGO guidelines), unplanned hospital admission and period for renal function normalization and hospital stay. Data were also compared with the retrospective data from patients with rectal surgery and loop ileostomy in 2014 to 2018.
Result & Outcome :
Results 66 patients (46 male & 20 female) were followed prospectively. The mean age was 64.6 years. 25 of them received neoadjuvant chemoradiotherapy. 11 patients had pre-existing diabetes. 2 patients (3.03%) developed acute kidney injury, and required emergency admission for rehydration within 2-month follow-up period postoperatively. In comparison with data in 2014-2018 before the program was implemented, there was less incidence of unplanned readmission for acute kidney injury (3.03% vs 7.69%). Furthermore, there were shorter hospital stay for rehydration, quicker normalization of renal function and less ICU admission for renal support after the program implementation. 7 patients required regular dose of loperamide upon discharge for high output stoma, and 5 out of these 7 patients had normal stomal output and normal renal function on the follow-up. Conclusions High output ileostomy program is effective in minimizing acute kidney injury and unplanned readmission for rehydration.
