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Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group). Bowel stimulation consisted of 10 outpatient sessions within\u00a0the 3\u00a0weeks prior to ileostomy closure and was performed by trained Enterostomal Therapy nurses. The primary outcome was POI, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, on or after postoperative day 3, that either (a) required nasogastric tube insertion; or (b) was associated with two of the following: nausea\/vomiting, abdominal distension, or the absence of flatus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between January 2017 and November 2020, 101 patients were randomized, and 5 patients never underwent ileostomy closure; thus, 96 patients (47 stimulated vs. 49 control) were analyzed according to a modified intention-to-treat protocol. Baseline characteristics were well balanced in both groups. The incidence of POI was lower among patients randomized to stimulation (6.4% vs. 24.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034; unadjusted RR: 0.26, 95% CI 0.078\u20130.87). Stimulated patients also had earlier median time to first flatus (2.0\u00a0days (1.0\u20132.0) vs. 2.0\u00a0days (2.0\u20133.0),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025), were more likely to pass flatus on postoperative day 1 (46.8% vs. 22.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022), and had a shorter median postoperative hospital stay (3.0\u00a0days (2.0\u20133.5) vs. 4.0\u00a0days (2.0\u20136.0),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative bowel stimulation via the efferent limb of the ileostomy reduced POI after elective loop ileostomy closure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-022-09510-5","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T10:02:28Z","timestamp":1660903348000},"page":"3934-3943","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial"],"prefix":"10.1007","volume":"37","author":[{"given":"Richard","family":"Garfinkle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Demian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Sabboobeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeongyoon","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hulme-Moir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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Chadi receives speaking honoraria from Stryker Endoscopy. Richard Garfinkle, Marie Demian, Sarah Sabboobeh, Jeongyoon Moon, Michael Hulme-Moir, A. Sender Liberman, Stan Feinberg, Dana M. Hayden, Sebastian Demyttenaere, Louise Samuel, Nevart Hotakorzian, Laurence Quintin, Nancy Morin, Julio Faria, Gabriela Ghitulescu, Carol-Ann Vasilevsky, Marylise Boutros, John Jarvis, Andrew Herd, Andrew Moot, Siraj Rajaratnam, Sherry Nisbet, Patrick Charlebois, Lawrence Lee, Barry Stein, Peter Stotland, Usmaan Hameed, Anuradha R. Bhama, Fayez Quereshy, and Donna Tataryn have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}