Outcome of Ileostomy Reversal Following Anterograde Efferent Limb Lavage Compared with Conventional Closure Techniques

Abstract

Background: Temporary loop ileostomy is commonly created to protect distal colorectal anastomoses, but ileostomy reversal is frequently complicated by delayed postoperative bowel recovery and prolonged hospitalisation. Anterograde efferent limb lavage has been proposed as a simple adjunct to improve bowel function after stoma closure; however, evidence regarding its effectiveness remains limited and inconsistent. Aim: This study aimed to compare postoperative outcomes following ileostomy reversal with anterograde efferent limb lavage versus conventional closure. Materials and Methods: This single-centre, non-randomised quasi-experimental study was conducted in the Department of Colorectal Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, between July 2023 and June 2024. Seventy consecutive patients undergoing reversal of a protective loop ileostomy after colectomy or proctectomy were enrolled and allocated to either the anterograde efferent limb lavage group (n = 35) or the conventional closure group (n = 35). The primary outcomes were measures of postoperative bowel recovery, including time to first passage of flatus, first passage of stool, recovery to the first meal, and tolerance of an oral diet. Secondary outcomes included postoperative wound infection, diarrhoea, anastomotic leakage, intestinal obstruction, and length of hospital stay. Statistical analyses were performed using SPSS version 25.0, with a two-sided p-value < 0.05 considered statistically significant. Results: Baseline demographic and operative characteristics were comparable between the two groups. Patients who underwent anterograde efferent limb lavage experienced significantly faster postoperative bowel recovery than those who underwent conventional closure. The mean time to diet tolerance was 1.45 ± 0.70 versus 2.28 ± 1.01 days; the mean time to first passage of flatus was 1.60 ± 0.73 versus 2.85 ± 1.28 days; the mean time to first passage of stool was 1.62 ± 0.77 versus 2.88 ± 1.27 days; the mean time to recovery to the first meal was 49.3 ± 3.1 versus 54.9 ± 3.9 hours; and the mean time to oral diet tolerance was 68.8 ± 4.0 versus 92.8 ± 5.5 hours (all p < 0.001). The mean postoperative hospital stay was also significantly shorter in the lavage group (2.3 ± 0.5 vs. 4.2 ± 1.4 days, p < 0.001). Rates of postoperative diarrhoea (2.9% vs. 5.7%), wound infection (14.3% vs. 20.0%), anastomotic leakage (0% vs. 0%), and intestinal obstruction (0% vs. 0%) did not differ significantly between the groups. Conclusion: Preoperative anterograde efferent limb lavage was associated with earlier postoperative bowel recovery and a shorter hospital stay following ileostomy reversal, without an increase in postoperative complications. These findings suggest that anterograde lavage may be a safe and practical adjunct to conventional ileostomy closure. However, because this was a single-centre, non-randomised study with a relatively small sample size, larger multicentre randomised controlled trials are required to confirm these findings.