ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2016
Water-Soluble Enema Prior to Ileostomy Closure in Patients Undergoing Low Anterior Resection: Is It Necessary?
Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Preoperative anastomotic evaluation prior to ileostomy closure: A 5-year UK survey, systematic review, and meta-analysis.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025Pooled it
- Pictorial review: radiological diagnosis of anastomotic leakage with water-soluble contrast enema after anterior resection of the rectum.Japanese journal of radiology · 2022Article
- Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma.Techniques in coloproctology · 2022Article
- Less is more-the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal.International journal of colorectal disease · 2021Review
- Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal.International journal of colorectal disease · 2021Article
- Is water-soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?JGH open : an open access journal of gastroenterology and hepatology · 2020Article
- Delayed Bowel Perforation after Routine Distal Loopogram Prior to Ileostomy Closure.Open medicine (Warsaw, Poland) · 2020Article
- Before and after Anorectal Surgery: Which Information Is Needed from the Functional Laboratory?Visceral medicine · 2018Review
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiverting ileostomy is recommended in patients undergoing neoadjuvant chemoradiotherapy and low anterior resection for low-rectal cancer. Prior to ileostomy reversal, water-soluble enema is performed to assess the low colorectal anastomosis. The aim of this study was to assess whether performance of routine water-soluble enema prior to ileostomy takedown is necessary. MATERIALS AND
methodsAll mid-low rectal cancer patients who underwent low anterior resection with temporary diverting ileostomy after neoadjuvant chemoradiotherapy, between 2006 and 2013, were identified, retrospectively. The colorectal anastomosis prior to ileostomy takedown was evaluated by digital rectal exam, rigid proctoscopy, and water-soluble enema. The rectal exam and proctoscopy findings were compared to those of the water-soluble enema. The efficacy of routine water-soluble enema was assessed.
resultsThree hundred and twelve (184 male) patients (mean age 62.2 ± 17 years) met the inclusion criteria. Ten patients (3 %) experienced a contained anastomotic leak in the early postoperative period, of whom six had a positive intraoperative air leak test at the index operation. At follow-up, 12 patients (4 %) presented with anastomotic stricture, which was diagnosed by rectal exam and proctoscopy. In 11 of them, water-soluble enema showed anastomotic stricture. In terms of anastomotic defects, sinus was documented in two patients (0.6 %), yet digital rectal exam and proctoscopy were normal. No late septic complications related to the colorectal anastomosis after ileostomy closure were reported. The sensitivity of rectal exam, and proctoscopy for the diagnosis of anastomotic stricture was 100 %, while its negative predictive value for the diagnosis of anastomotic defect was 99 %.
conclusionRoutine water-soluble enema for the evaluation of colorectal anastomosis before ileostomy takedown does not provide additional information that changes patient management. The efficacy of this test in patients after neoadjuvant chemoradiotherapy and low anterior resection should be reassessed.
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