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Session: ePoster Monitor 9 - Late Breaking ePosters 2

eP809 - A Prospective Randomized Trial of Low Fiber Diet vs. Regular Diet in Postoperative Colorectal Patients with Ileostomies

Monday, June 3, 2024
10:18 AM – 10:23 AM ET, USA
Location: Room 318-320

    ePoster Presenter(s)

  • Lucille Yao, MD

    Cedars-Sinai Medical Center
    Cedars-Sinai Medical Center

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Evan D. Adams, MD

    Resident Phyician
    Cedars-Sinai
    Los Angeles, CA, United States

    Disclosure information not submitted.

  • CB

    Charles Browning, MD

    Cedars Sinai Medical Center

    Disclosure information not submitted.

  • Alessandra Storino, MD

    Colorectal Surgery Fellow
    Cedars Sinai Medical Center
    Cedars Sinai Medical Center
    Los Angeles, CA, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

  • Phillip Fleshner, MD FASCRS

    CEDARS SINAI MEDICAL CENTER
    CEDARS SINAI MEDICAL CENTER

    Disclosure information not submitted.

    • Senior Author(s)

  • Karen Zaghiyan, MD

    Assistant Professor of Surgery
    Cedars-Sinai
    Cedars Sinai Medical Center
    Los Angeles, California, United States

    Disclosure information not submitted.

Image or Table (Do Not add text here):

Purpose/Background: Postoperative ileus and obstruction are among the most common complications hindering successful recovery for patients undergoing colorectal surgery with ileostomy creation. Guidelines on diet after ileostomy surgery are largely based on anecdote and recommend a low fiber diet to minimize the risk of ileus and obstruction. We hypothesize that feeding a regular diet is non-inferior to feeding a low fiber diet in terms of rate of postoperative ileus in patients undergoing major colorectal surgery with formation of ileostomy.Methods/Interventions: We conducted a single center, randomized trial of patients undergoing elective or urgent colorectal surgery resulting in a loop or end ileostomy beginning November 2020. Here we report the results of a planned interim safety analysis at 50% patient accrual. Eligible participants were fed clear liquids on postoperative day zero, then randomized 1:1 to receive either low fiber diet (Arm LF) or regular unrestricted diet (Arm R) starting postoperative day 1. Patient demographics, operative factors, postoperative oral intake, pain, opioid intake, nausea, and ileostomy output were recorded. The primary outcome was rate of postoperative ileus, defined as inability to tolerate oral diet with or without nasogastric tube decompression. Secondary outcomes included rate of postoperative bowel obstruction, hospital length of stay, 30-day and 90-day hospital readmission rates, rate of high stoma output requiring antidiarrheal medication, rate of 30-day and 90-day reoperation, and overall quality of life measured using the Gastrointestinal Quality of Life Index (GIQLI) on POD 90 or up to the date of stoma reversal. Fisher’s Exact Test and Mann-Whitney U-test were used to compare outcomes.Results/Outcomes: The study cohort of 74 patients had a median age of 47 (range, 18-79) years and included 40 (54%) females. Length of follow up was 90 days postoperatively. There were no significant differences between groups in terms of preoperative and surgical characteristics (Table). The study primary endpoint, rate of postoperative ileus, was similar between groups with 8 patients in Arm LF (22%) and 6 patients in Arm R (16%) exhibiting symptoms consistent with postoperative ileus (p=0.38). However, rate of postoperative bowel obstruction was significantly higher in the regular diet arm (19%) compared to the low fiber diet arm (0%) (p=0.01).There was no significant difference in any other secondary endpoint.Conclusion/

Discussion: Interim results of this randomized trial suggest that regular diet starting POD 1 in patients undergoing colorectal surgery with a newly created ileostomy is not associated with a higher rate of postoperative ileus compared patients fed a low fiber diet, but may be associated with a higher rate of postoperative bowel obstruction. Although the study was not originally powered to detect a difference in rate of postoperative bowel obstruction, further investigation into this finding will be conducted.Table