Delays in stoma reversal surgery do not affect post-operative clinical outcomes

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Patients can be reassured that delays in stoma reversal surgery do not affect long-term outcomes according to research funded by Bowel Cancer UK and North West Cancer Research.

The Lancaster University study was led by Dr Rachael Rigby from the Faculty of Health and Medicine as part of a long-standing collaboration between Lancaster University, Lancashire Teaching Hospitals NHS trust and the University Hospitals of Morecambe Bay NHS Trusts.

Stoma reversal aims to reverse a colostomy in, for example, patients recovering from bowel cancer. But post-surgical complications, such as loss of bowel function or inflammation, are common.

The study aims to improve outcomes of patients in those which have undergone this relatively common type of surgery

Dr Rigby led a team which examined historic tissue samples from part of the colon which would normally be discarded during stoma reversal surgery as well as examining the bacteria living within the bowel.

She said: "We gained pilot data from historic tissue samples and obtained funding from Bowel Cancer Research and North West Cancer Research enabling us to fund students to analyze additional tissue samples and commensal microbiota, bacteria which reside within the bowel."

In 2017, the team published research showing that commensal microbiota are depleted in the defunctioned bowel.

Further funding, from the NIHR Research Design Service North West, led to a Public and Patient Involvement event at Lancashire Teaching Hospitals NHS Trust, to gather feedback from patients who had experienced, or were due to undergo, surgery.

The participants' main concern was whether a delay in reversal surgery, particularly following the SARS-Cov-19 pandemic, would increase the likelihood of developing complications.

Dr Rigby said: "This follow-up study is the first to show that delaying stoma reversal surgery does not impact on risk of complications or commensal microflora loss, atrophy or scarring.

"However, a higher degree of microflora loss is associated with an increased risk of complications. This loss appears to be related to the overall number of bacteria present, rather than the loss of specific types of bacteria. This is of great importance to finding ways to reduce post-surgical complications in patients."

Researchers are currently seeking funding to support a clinical trial, to test whether feeding the commensal microflora through the stoma prior to surgery can increase numbers and improve the outcomes of reversal surgery.

Source:
Journal reference:

Beamish, E. L., et al. (2023). Delay in loop ileostomy reversal surgery does not impact upon post-operative clinical outcomes. Complications are associated with an increased loss of microflora in the defunctioned intestine. Gut Microbes. doi.org/10.1080/19490976.2023.2199659.

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