Clinical Pathway for Four-days Postoperative Hospital Stay following Ileostomy Closure

Kazuhiro Narita, Akira Tsunoda, Kentaro Nakao, Goichi Kamiyama, Katsuo Yamazaki, Makoto Watanabe, Naoto Suzuki, Tohru Ohnaka, Kohji Takenaka and Mitsuo Kusano

Department of General and Gastroenterological Surgery, Showa University School of Medicine

Temporary loop stoma has been used in sphincter-preserving rectal cancer surgery and the stoma closed in regular surgery. Few reports have, however, been on the clinical pathway for loop ileostomy closure. We assessed the feasibility of a clinical pathway for this. Subjects were 26 patients undergoing ileostomy closure since April 2004. Clinical results for 12 managed based on the pathway (CP group) were compared to those for 14 treated by introduction of the pathway (NCP group). The CP group was hospitalized the day before surgery and discharged on postoperative day (POD) 4. Postoperative gastric ileus was examined with radiopaque markers. After having introduced the pathway, execution was 100%. Postoperative time to intake in the CP group (median, 1 day) was significantly shorter than that in NCP group (median, 2 days). Hospitalization in the CP group (median, 6.5 days) was significantly shorter than that in NCP group (median, 15days). The postoperative hospital stay in the CP group (median, 4 days) was shorter than that in the NCP group (median, 10 days). More than 70% of markers had been emptied from the stomach in 83% of patients by POD 1. Gastric ileus may be mostly resolved on POD 1. Nine of the 12 patients (75.0%) in the CP group were discharged on POD 4. A 4-day hospital stay following ileostomy closure as the clinical path is feasible.

Key words
ileostomy closure, clinical pathway

Reprint requests
Kazuhiro Narita Department of General and Gastroenterological Surgery, Showa University School of Medicine
1-5-8 Hatanodai, Shinagawa-ku, 142-8666 JAPAN

Accepted
May 30, 2007

To read the PDF file you will need Abobe Reader installed on your computer.