A clinical study of anterograde lavage via temporary loopileostomy to improve bowel function after intersphincterectomy for low rectal cancer
Objective To explore the postoperative anal function and bowel function in patients undergoing intersphincteric resection(ISR)with ileostomy for low rectal cancer with a probiotic enema by anterograde lavage.Methods The clinical data of 85 patients who underwent ISR and ileostomy for low rectal cancer in the Department of Colorectal and Anal Surgery of Wuhan University Zhongnan Hospital from January 2018 to December 2022 were selected.The patients were divided into the probiotic enema by anter-ograde lavage group or non-enema group,and the baseline data and clinical indicators of the two groups were compared.The postoperative complications,anal function,and bowel function at 1st,3rd,and 6th month after surgery were evaluated through questionnaires and clinical data.The independent sample t-tests,Wilcoxon rank sum tests,chi-square tests,or chi-square tests with continuity correction were used to compare the clinical efficacy of the two groups.Results The probiotic lavage group had lower Wexner scores,anterior resection syndrome scores(LARS scores),and Mayo endoscopic subscore(Mayo scores)at 1st,3rd,and 6th months after stoma reversal,as well as shorter first exhaust and defecation time and a lower complication rate than the non-lavage group[(11.60±1.97)vs.(13.23±3.47),(9.40±2.50)vs.(11.17±3.65),(7.08±1.75)vs.(9.38±2.58),t=2.730,2.207,4.757,P＜0.05;Z=-2.145,-2.519,-2.165,P＜0.05;Z=-3.332,P＜0.05,(36.12±13.56)h vs.(57.67± 16.60)h,(41.88±16.06)h vs.(60.15±16.64)h,8％(2/25)vs.31.7％(19/60),t=5.735,4.657,4.117,P＜0.05].The probiotic lavage group also had higher fecal incontinence quality of life scores(FIQL scores)at 1st,3rd,and 6th month after stoma reversal than the non-lavage group:Lifestyle[(1.69±0.20)vs.(1.36±0.21),(2.06±0.22)vs.(1.77±0.24),(2.34±0.25)vs.(2.01± 0.31),t=-6.498,-5.317,-4.744,P＜0.05],Coping[(1.67±0.26)vs.(1.49±0.27),(1.90±0.35)vs.(1.73±0.33),(2.38±0.35)vs.(2.15±0.37),t=-2.715,-2.056,-2.585,P＜0.05],Depression[(2.19±0.34)vs.(1.81±0.31),(2.37±0.47)vs.(2.04±0.50),(3.09± 0.36)vs.(2.76±0.64),t=-5.048,-2.827,-2.902,P＜0.05],Embarrassment[(2.15±0.66)vs.(1.76±0.55),(2.31±0.75)vs.(1.95±0.64),(2.61±0.76)vs.(2.22±0.67),t=-2.788,-2.264,-2.284,P＜0.05].There was no significant difference in anal resting pressure(ARP),maxi-mum squeeze pressure(MSP),maximum tolerance volume(MTV),or rectal compliance(RC)between the two groups at 3rd and 6th month after stoma reversal[(30.07±6.17)mmHg vs.(26.54±4.34)mmHg,(33.46±6.22)mmHg vs.(29.33±4.70)mmHg;(97.13±8.23)mmHg vs.(90.84±12.07)mmHg,(105.63±8.12)mmHg vs.(100.67±13.09)mmHg;(56.50±6.39)ml vs.(59.50±8.01)ml,(62.3± 6.48)ml vs.(63.30±7.90)ml;(5.72±1.27)ml/mmHg vs.(5.65±1.15)ml/mmHg,(8.20± 1.52)ml/mmHg vs.(7.81±1.54)ml/mmHg,t=-1.478,-1.675,-1.361,-1.018,0.925,0.309,-0.128,-0.568,P＞0.05].Conclusion Anterograde lavage via temporary loop ileostomy with probiotic enema can improve the postoperative bowel function and defecation symptoms of ISR patients to a certain ex-tent,enhance the patient's quality of life,and accelerate the patients'postoperative intestinal recovery.
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