SSAT - CHYME REINFUSION IN CASES WITH HIGH OUTPUT DOUBLE LUMEN ENTEROSTOMIES AND ENTEROCUTANEOUS FISTULAS IS A VALUABLE OPTION FOR REDUCED ADVERSE POSTOPERATIVE OUTCOMES: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS.

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CHYME REINFUSION IN CASES WITH HIGH OUTPUT DOUBLE LUMEN ENTEROSTOMIES AND ENTEROCUTANEOUS FISTULAS IS A VALUABLE OPTION FOR REDUCED ADVERSE POSTOPERATIVE OUTCOMES: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS.
Sascha Vaghiri¹, Dimitrios Prassas¹, Wolfram Trudo Knoefel¹, Hermann Kessler^*²
¹General-, visceral- and pediatric surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany; ²Cleveland Clinic, Cleveland, OH

Background: Chyme reinfusion (CR) is a simple technique that reestablishes gastrointestinal continuity. The primary objective was to analyze the pooled evidence of the CR effect on postoperative outcomes following ostomy or fistula closure.
Methods: This meta-analysis was performed according to the current PRISMA guidelines and included all studies that provided postoperative outcome data on CR compared to the control group (no CR) in high output ostomies and enterocutaneous fistulas. Data from eligible studies were extracted, qualitatively assessed, and included. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the ROBINS-I criteria.
Results: Five eligible studies with a total of 460 patients were included (CR: n= 219, control: n= 241). CR demonstrated significantly lower rates of overall complications (OR 0.25, 95% CI 0.13-0.46, p < 0.00001), ileus (OR 0.35, 95% CI 0.22-0.53, p < 0.00001), and diarrhea (OR 0.29, 95% CI 0.12-0.69, p = 0.005). As a result, the hospital stay was significantly reduced in the CR group as compared to the control group (SMD -0.76, 95% CI -1.46 to -0.07, p = 0.03). In addition, the postoperative inflammatory markers CRP (C-reactive protein) (SMD -0.76, 95% CI -0.98 to -0.53, p < 0.0001) and WBC (white blood count) (SMD -0.67, 95% CI -1.09 to -0.25, p = 0.002) were significantly lower after CR.
Conclusions: CR is a safe and easy-to-use method which leads to a significant reduction in inflammatory response and postoperative complications such as ileus or diarrhea and thus significantly shortens the hospital stay. This method should therefore be considered as an additional supportive procedure for patients with high output ostomies or fistulas. The further legitimacy and justification of CR should now be verified in multi-center randomized studies.

Fig. 1. : Forrest plots for primary outcomes CR versus control: a) Overall complications. b) Hospital stay.

Fig. 2. : Forrest plots for secondary outcomes CR versus control: a) Surgical site infection. b) Surgery duration. c) Ileus. d) Diarrhea.

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