{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T07:14:32Z","timestamp":1763968472819,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T00:00:00Z","timestamp":1648857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Anastomotic leakage remains the most feared complication in colorectal surgery. Various intraoperative tests evaluate bowel perfusion and mechanical integrity of the colorectal anastomosis. These tests reduce the risk of postoperative anastomotic leakage; however, the incidence remains high. Diverting loop ileostomy mitigates the damage if anastomotic leakage occurs. Nevertheless, ileostomy has a significant rate of complications, reducing patients\u2019 quality of life, and requiring an additional operation. We evaluated six consecutive cases where bowel rest with total parenteral nutrition was used instead of diverting loop ileostomy. All colorectal anastomoses were at high risk of postoperative anastomotic leakage. Total parenteral nutrition was administered for the first seven days postoperatively. There were no serious complications during the recovery period, and no clinical postoperative anastomotic leakage was detected. All patients tolerated total parenteral nutrition. Bowel rest with total parenteral nutrition may be a feasible option in high-risk left-sided colorectal anastomosis and a possible alternative to a preventive loop ileostomy. Further studies are necessary to evaluate it on a larger scale.<\/jats:p>","DOI":"10.3390\/medicina58040510","type":"journal-article","created":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T02:59:52Z","timestamp":1648954792000},"page":"510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bowel Rest with Total Parenteral Nutrition as an Alternative to Diverting Ileostomy in High-Risk Colorectal Anastomosis: A Pilot Study"],"prefix":"10.3390","volume":"58","author":[{"given":"Marius","family":"Kryzauskas","sequence":"first","affiliation":[{"name":"Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0789-2067","authenticated-orcid":false,"given":"Matas","family":"Jakubauskas","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neda","family":"Gendvilaite","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vilius","family":"Rudaitis","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6931-6041","authenticated-orcid":false,"given":"Tomas","family":"Poskus","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e23135","DOI":"10.1097\/MD.0000000000023135","article-title":"Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak: A meta-analysis","volume":"99","author":"Kryzauskas","year":"2020","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/jso.25488","article-title":"Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial","volume":"120","author":"Bausys","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1007\/s10350-006-0541-2","article-title":"Morbidity of Temporary Loop Ileostomy in Patients with Colorectal Cancer","volume":"49","author":"Thalheimer","year":"2006","journal-title":"Dis. Colon Rectum"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1093\/bjs\/znab260","article-title":"Permanent stoma rates after anterior resection for rectal cancer: Risk prediction scoring using preoperative variables","volume":"108","author":"Back","year":"2021","journal-title":"Br. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5073","DOI":"10.3748\/wjg.14.5073","article-title":"Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support","volume":"14","author":"Wang","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/BF02586692","article-title":"Use of total parenteral nutrition as a \u201cMedical colostomy\u201d in management of severe lacerations of the sphincter: Report of a case","volume":"20","author":"Sohn","year":"1977","journal-title":"Dis. Colon Rectum"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s00464-019-06730-0","article-title":"Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: Results of a multicenter randomized controlled trial","volume":"34","author":"Elmore","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/DCR.0000000000002007","article-title":"Perfusion Assessment in Left-Sided\/Low Anterior Resection (PILLAR III): A Randomized, Controlled, Parallel, Multicenter Study Assessing Perfusion Outcomes with PINPOINT Near-Infrared Fluorescence Imaging in Low Anterior Resection","volume":"64","author":"Jafari","year":"2021","journal-title":"Dis. Colon Rectum"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15930","DOI":"10.1038\/s41598-017-16311-7","article-title":"Temporary Diverting Stoma Improves Recovery of Anastomotic Leakage after Anterior Resection for Rectal Cancer","volume":"7","author":"Wu","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20816","DOI":"10.18632\/oncotarget.25015","article-title":"Defunctioning ileostomy reduces leakage rate in rectal cancer surgery\u2014Systematic review and meta-analysis","volume":"9","author":"Pisarska","year":"2018","journal-title":"Oncotarget"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00268-012-1772-0","article-title":"Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery after Surgery (ERAS\u00ae) Society Recommendations","volume":"37","author":"Gustafsson","year":"2013","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1177\/000313481608201039","article-title":"Complications of Diverting Ileostomy after Low Anterior Resection for Rectal Carcinoma","volume":"82","author":"Maroney","year":"2016","journal-title":"Am. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4809","DOI":"10.1007\/s00464-016-4811-3","article-title":"Diverting ileostomy in laparoscopic rectal cancer surgery: High price of protection","volume":"30","author":"Peteja","year":"2016","journal-title":"Surg. 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