Colonic motility after colonsurgery with diverting stoma; observational study

Introduction:
After colorectal surgery anastomotic leakage is one of the most important
complications. This complication has high impact on morbidity and mortality
rate. [1,2] Several studies show that a temporary diverting ileostomy protect
the distal anastomosis, especially when anastomosis is nearby the rectum.

One of the arguments for a diverting stomy is to prevent faecal contamination
of the anatomosis. However, programmes for enhanced recovery after colorectal
surgery abolished mechanical bowel preparation. As a consequence faeces remains
in the descending loop that can pass the anastomosis. Interestingly, the
incidence rate of anastomotic leakage has not been increased after installation
of ERAS- programmes. This is shown both in the Amphia Hospital as in other
hospitals. [3,4]

It suggests another cause for the protective role of the ileostomy than
preventing fecal contamination. We suggest an alternative possibility, that the
stomy prevents continuation of the peristaltic wave along the gut and in this
way reduces the intracolonic pressure on the anastomosis.

Purpose:
We like to determine the movement of the intestinal contents to measure the
peristaltic movement/ motility.

Observational study

The risk and extend of burden for the patient is minimal. Radiation pollution
will be in total two x-rays of the abdomen, this will be in total 0.3 mSievert
per x-ray.
The colonic transit time will be determined with one capsule which contain
twelve radiopaque rings, so-called Sitzmarker. This capsule dissolves very easy
in the gastro-intestinal tract. When the capsule dissolves, the twelve rings
will pursue their way through the colon or remain in position in cases without
no or less motility.