{"product_id":"life-after-ileocecal-valve-removal-how-bowel-function-quality-of-life-and-vitamin-b12-levels-are-affected","title":"Life After Ileocecal Valve Removal: How Bowel Function, Quality of Life, and Vitamin B12 Levels Are Affected","description":"\u003cp\u003eThis was a prospective, multicentric study of 158 patients. These patients had the ileocecal valve (the valve connecting the small and large bowel) removed during right colectomy or ileocecal resection. Researchers found that health-related quality of life (how well patients feel and function day to day) actually improved over the 6-month follow-up period. Bowel symptoms such as abdominal pain, bloating, nausea, constipation, and frequent bowel movements all got better after surgery, although diarrhea briefly worsened before improving. No patient developed a clinically significant vitamin B12 deficiency, even when 20 cm or more of ileum was removed. However, women, patients who had open surgery, and those with more advanced cancer stages reported more persistent bowel symptoms. So the authors conclude that warning patients about possible changes in bowel habits remains essential.\u003c\/p\u003e\n\n\u003ch1\u003eIleocecal valve syndrome and vitamin b12 deficiency after surgery\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Question Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Study Was Designed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#participants\"\u003eWho Took Part in the Study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#giqli\"\u003eQuality of Life Results: The General Digestive Questionnaire\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#cr29\"\u003eQuality of Life Results: The Cancer-Specific Questionnaire\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#predictors\"\u003eWhich Patients Had More Lasting Symptoms?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#b12\"\u003eVitamin B12 Levels After Surgery\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eWhat These Findings Mean for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of the Study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003ePractical Recommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn a study of 158 patients, abdominal pain, bloating, nausea, constipation, and bowel frequency improved significantly over six months after ileocecal valve removal.\u003c\/li\u003e\n\u003cli\u003eDiarrhea temporarily worsened at two weeks after surgery before improving by six weeks; gas and stool leakage stayed about the same.\u003c\/li\u003e\n\u003cli\u003eNo patient developed clinically significant vitamin B12 deficiency, even with 20 cm or more of ileum removed, but those patients showed a downward trend.\u003c\/li\u003e\n\u003cli\u003eWomen, older patients, those who had open surgery, those with advanced cancer, and those with longer bowel segments removed reported more lasting symptoms.\u003c\/li\u003e\n\u003cli\u003eThe study was observational, had short follow-up, and mostly included cancer patients, so findings apply most confidently to that group.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Question Matters\u003c\/h2\u003e\n\n\u003cp\u003eThe ileocecal valve (ICV), also called the ileocecal junction, is a muscular sphincter valve — a ring of muscle that opens and closes like a gate. It separates the small bowel (ileum) from the large bowel (colon). It controls how digested food passes through, under the influence of hormones and nerve fibers.\u003c\/p\u003e\n\n\u003cp\u003eWhen surgeons remove this valve during right colectomy or ileocecal resection, bacteria that normally live in the colon can move backward into the ileum. Under certain circumstances, this backward movement can lead to a condition called small intestinal bacterial overgrowth, or SIBO (too many bacteria growing in the upper part of the gut).\u003c\/p\u003e\n\n\u003cp\u003eSIBO is not rare. The reported prevalence in the general population ranges from 0% to 20%. After removal of the ileocecal valve, that number rises to as much as 32%.\u003c\/p\u003e\n\n\u003cp\u003eSIBO symptoms are usually vague and non-specific. Patients may notice abdominal discomfort, bloating, and diarrhea. In more serious cases, SIBO can cause malabsorption (poor absorption of nutrients), malnutrition, and vitamin B12 deficiency.\u003c\/p\u003e\n\n\u003cp\u003eVitamin B12 deserves special attention here. This vitamin is actively absorbed only in the terminal ileum (the last section of the small bowel). However, a small amount is passively absorbed throughout the entire small bowel. Because of that backup mechanism, ileal resections (surgical removals of ileum) shorter than 20 cm generally do not put patients at risk of vitamin B12 deficiency.\u003c\/p\u003e\n\n\u003cp\u003eRight colectomy and ileocecal resection are very common operations. They are performed for both cancerous and non-cancerous diseases, and both as planned (elective) surgery and as emergency surgery. Patients frequently ask what their bowel function will be like afterward.\u003c\/p\u003e\n\n\u003cp\u003eA small number of patients do report a clinically relevant worsening of bowel habits, vitamin deficiency, and a drop in quality of life over the long term. The authors note that in their experience this can even become a source of medical-legal complaints. Understanding what actually happens — and how often — is therefore important for both patients and surgeons.\u003c\/p\u003e\n\n\u003cp\u003eThis study had two goals. The primary aim was to evaluate intestinal activity and quality of life in patients who had an uncomplicated recovery after right colectomy or ileocecal resection. This applied whatever the reason for the operation. The secondary aim was to assess vitamin B12 deficiency after surgery and whether patients needed vitamin supplements.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Study Was Designed\u003c\/h2\u003e\n\n\u003cp\u003eThis was a prospective, longitudinal, observational, multicentric study. In plain terms: patients were enrolled and then followed forward in time, across multiple hospitals, without the researchers assigning any particular treatment. The study ran from November 2016 to May 2018 at six Italian centers and one Slovenian colorectal surgery center.\u003c\/p\u003e\n\n\u003cp\u003ePatients were eligible if they were 16 years or older and underwent a right colectomy, an extended right colectomy, or an ileocecal resection. The reason for surgery could be malignant (cancerous) or benign (inflammatory or ischemic, meaning caused by reduced blood flow). Both elective and emergency operations were included.\u003c\/p\u003e\n\n\u003cp\u003eSurgery was performed by open approach (a traditional incision), laparoscopic approach (keyhole surgery, with the reconnection performed either inside or outside the body), or robotic approach.\u003c\/p\u003e\n\n\u003cp\u003eResearchers excluded certain patients to keep the results interpretable:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003ePatients who had palliative surgery (surgery intended to relieve symptoms, not cure disease)\u003c\/li\u003e\n  \u003cli\u003ePatients with a diverting stoma (an opening on the abdomen that reroutes stool)\u003c\/li\u003e\n  \u003cli\u003ePatients with postoperative complications graded 3b or higher on the Clavien-Dindo classification (a standard scale for surgical complications, where higher grades mean more serious problems requiring further intervention)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe study was approved by all centers under Protocol Number 5903 by the Local Ethical Committee of Trieste University Hospital. Every participant gave written informed consent.\u003c\/p\u003e\n\n\u003cp\u003eFor each patient, the researchers recorded age, gender, and whether the disease was benign or malignant. The researchers recorded the type of operation and the length of the removed surgical specimen (total length, length of ileum, length of colon). The researchers recorded cancer stage according to the AJCC classification (the standard system for staging cancer). The researchers also recorded whether the patient received adjuvant therapy (additional treatment after surgery, such as chemotherapy).\u003c\/p\u003e\n\n\u003ch3\u003eHow Bowel Function and Quality of Life Were Measured\u003c\/h3\u003e\n\n\u003cp\u003eThe team used two validated questionnaires. \"Validated\" means the questionnaires have been formally tested and shown to reliably measure what they claim to measure.\u003c\/p\u003e\n\n\u003cp\u003eThe first was the Gastrointestinal Quality of Life (GIQLI) questionnaire. It was given to every patient, including those with inflammatory, ischemic, or neoplastic (tumor-related) disease. The GIQLI was completed at the time of surgery, 2 weeks after surgery, and 6 weeks after surgery. Researchers focused on specific items: abdominal pain, bloating, bowel frequency, bowel urgency, bowel movement, diarrhea, constipation, and nausea — question numbers 1, 3, 7, 30, 31, 32, 33, and 36.\u003c\/p\u003e\n\n\u003cp\u003eThe GIQLI uses a five-point scale to show how much symptoms affected quality of life. The scale is: \"0 = never,\" \"1 = rarely,\" \"2 = sometimes,\" \"3 = most of the time,\" and \"4 = all the time.\" A lower score therefore means fewer symptoms.\u003c\/p\u003e\n\n\u003cp\u003eThe second questionnaire was the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR29 module. It was given only to patients with cancer. It was completed at the time of surgery, 3 months after surgery, and 6 months after surgery. The selected items covered abdominal pain, bloating, gas and\/or fecal incontinence (loss of control over gas or stool), and frequency of bowel movements during the day. The selected items also covered frequency of bowel movements during the night — question numbers 35, 37, 49, 50, 52, and 53.\u003c\/p\u003e\n\n\u003cp\u003eThe QLQ-CR29 uses a four-point scale: \"1 = never,\" \"2 = occasionally,\" \"3 = most of the time,\" and \"4 = all the time.\" Again, lower is better.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers defined chronic sequelae (lasting after-effects) as persistent symptoms producing a GIQLI score of 3 or higher at 6 weeks after surgery. Chronic sequelae also included a QLQ-CR29 score of 3 or higher at 6 months after surgery.\u003c\/p\u003e\n\n\u003ch3\u003eVitamin B12 Testing and Statistical Methods\u003c\/h3\u003e\n\n\u003cp\u003eBlood samples for vitamin B12 were collected at the time of surgery, 3 months after surgery, and 6 months after surgery. Serum vitamin B12 levels between 148 pg\/mL and 980 pg\/mL were considered within the normal range. The researchers also examined whether vitamin B12 levels correlated with the length of small bowel removed.\u003c\/p\u003e\n\n\u003cp\u003eData were collected prospectively in an anonymous database using Microsoft Excel 2007. Baseline characteristics were reported as mean ± standard deviation (SD) or as median with interquartile range. The median is the middle value, and the interquartile range describes the spread of the middle half of the data. Categorical variables were reported as frequency and percentage.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers used the Friedman test, a non-parametric test for paired data, to analyze variation in scores between baseline and follow-up. Non-parametric means the test does not assume the data follow a normal bell-shaped distribution. For post-hoc tests (follow-up comparisons performed after the main test), they used the Wilcoxon signed rank test, corrected with the Holm method to reduce the chance of false-positive findings.\u003c\/p\u003e\n\n\u003cp\u003eTo judge whether changes were clinically meaningful — not just statistically significant — the team used the minimal important difference (MID) concept. The team also used an approach called the empirical rule effect-size (ERES) calibration method. The ERES method defines a change of 8% in the theoretical range of a questionnaire as a clinically significant change in health-related quality of life (HRQL).\u003c\/p\u003e\n\n\u003cp\u003eIn practical numbers: an 8% change on the GIQLI's 0-to-4 range equals \u003cstrong\u003e0.32 points\u003c\/strong\u003e per item. An 8% change on the QLQ-CR29's 1-to-4 range equals \u003cstrong\u003e0.24 points\u003c\/strong\u003e per item.\u003c\/p\u003e\n\n\u003cp\u003eFinally, the team applied a linear mixed-effects (LME) model for longitudinal data. This statistical method identifies which patient-related, intraoperative (during surgery), and postoperative factors most strongly affect the total score over time.\u003c\/p\u003e\n\n\u003cp\u003eAll p values came from two-sided tests, with 0.05 used as the significance level. Analyses were performed with R 3.5.0 software and STATA 14.2.\u003c\/p\u003e\n\n\u003ch2 id=\"participants\"\u003eWho Took Part in the Study\u003c\/h2\u003e\n\n\u003cp\u003eThe study analyzed 158 patients who underwent right colectomy, right extended colectomy, or ileocecal resection between November 2016 and May 2018.\u003c\/p\u003e\n\n\u003cp\u003eOf these patients, 87 (55.0%) were male and 71 (45.0%) were female. The median age was 71 years, with a range from 16 to 91 years.\u003c\/p\u003e\n\n\u003cp\u003eCancer was the main reason for surgery, reported in 149 patients (93.3%). Of these, 148 had colonic adenocarcinoma (a type of cancer starting in the glandular cells of the colon) and 1 had a maltoma (a rare type of lymphoma, or cancer of the immune system cells). The remaining 9 patients (6.7%) had inflammatory or ischemic disease.\u003c\/p\u003e\n\n\u003cp\u003eCancer stages were distributed as follows:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eStage 0: 21 patients (14.2%)\u003c\/li\u003e\n  \u003cli\u003eStage I: 29 patients (19.6%)\u003c\/li\u003e\n  \u003cli\u003eStage II: 52 patients (35.1%)\u003c\/li\u003e\n  \u003cli\u003eStage III: 40 patients (27.0%)\u003c\/li\u003e\n  \u003cli\u003eStage IV: 4 patients (2.7%)\u003c\/li\u003e\n  \u003cli\u003eStage not recorded: 2 patients (1.4%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eOverall, 46 patients (30.8%) received postoperative adjuvant chemotherapy.\u003c\/p\u003e\n\n\u003cp\u003eRight colectomy was by far the most common operation, performed in 135 patients (85.4%). Within this group, 127 patients (94.1%) had malignant disease and 8 patients (5.9%) had benign disease. Extended right colectomy was performed in 20 patients (12.7%), all of whom had malignant disease. Ileocecal resection was performed in just 3 patients (1.9%) — 2 with malignant disease and 1 with benign disease.\u003c\/p\u003e\n\n\u003cp\u003eLaparoscopy was the preferred surgical approach, used in 117 cases (74.1%). Open surgery was used in 40 patients (25.3%), and robotic surgery in 1 patient (0.6%).\u003c\/p\u003e\n\n\u003cp\u003eThe median length of the removed surgical specimen was 31 cm, ranging widely from 16 cm to 152 cm. When broken down by segment, the median length of removed ileum was 8 cm (range 2–140 cm) and the median length of removed colon was 20 cm (range 4–55 cm).\u003c\/p\u003e\n\n\u003ch2 id=\"giqli\"\u003eQuality of Life Results: The General Digestive Questionnaire\u003c\/h2\u003e\n\n\u003cp\u003eOverall, 119 patients (75.3%) completed the GIQLI questionnaire before surgery, 118 patients (74.7%) completed it 2 weeks after surgery, and 111 patients (70.3%) completed it 6 weeks after surgery. This represents a drop-out rate of 29.7%. The statistical analysis included only patients who completed the full follow-up.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers found a significant difference in symptoms between baseline and follow-up for every item examined — except for uncontrolled stools.\u003c\/p\u003e\n\n\u003cp\u003eOver the 6-week follow-up period, there was a clinically relevant improvement in all examined items except diarrhea. In other words, most bowel symptoms got better, not worse.\u003c\/p\u003e\n\n\u003ctable\u003e\n  \u003ctr\u003e\n    \u003cth\u003eSymptom (GIQLI question)\u003c\/th\u003e\n    \u003cth\u003eBefore surgery\u003c\/th\u003e\n    \u003cth\u003e2 weeks after\u003c\/th\u003e\n    \u003cth\u003e6 weeks after\u003c\/th\u003e\n    \u003cth\u003ep value\u003c\/th\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eAbdominal pain (#1)\u003c\/td\u003e\n    \u003ctd\u003e1.73 ± 0.85\u003c\/td\u003e\n    \u003ctd\u003e1.50 ± 0.68\u003c\/td\u003e\n    \u003ctd\u003e1.35 ± 0.64*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eBloating — too much gas in the abdomen (#3)\u003c\/td\u003e\n    \u003ctd\u003e2.02 ± 0.90\u003c\/td\u003e\n    \u003ctd\u003e1.84 ± 0.63\u003c\/td\u003e\n    \u003ctd\u003e1.34 ± 0.56*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eFrequent bowel movements (#7)\u003c\/td\u003e\n    \u003ctd\u003e1.66 ± 0.77\u003c\/td\u003e\n    \u003ctd\u003e1.75 ± 0.70\u003c\/td\u003e\n    \u003ctd\u003e1.52 ± 0.67\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eUrgent bowel movements (#30)\u003c\/td\u003e\n    \u003ctd\u003e1.37 ± 0.71\u003c\/td\u003e\n    \u003ctd\u003e1.58 ± 0.78\u003c\/td\u003e\n    \u003ctd\u003e1.27 ± 0.66\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eDiarrhea (#31)\u003c\/td\u003e\n    \u003ctd\u003e1.39 ± 0.77\u003c\/td\u003e\n    \u003ctd\u003e1.70 ± 0.77*\u003c\/td\u003e\n    \u003ctd\u003e1.53 ± 0.72\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eConstipation (#32)\u003c\/td\u003e\n    \u003ctd\u003e1.98 ± 0.97\u003c\/td\u003e\n    \u003ctd\u003e1.29 ± 0.69*\u003c\/td\u003e\n    \u003ctd\u003e1.24 ± 0.61*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eNausea (#33)\u003c\/td\u003e\n    \u003ctd\u003e1.42 ± 0.79\u003c\/td\u003e\n    \u003ctd\u003e1.25 ± 0.68\u003c\/td\u003e\n    \u003ctd\u003e1.03 ± 0.46*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eUncontrolled stools (#36)\u003c\/td\u003e\n    \u003ctd\u003e1.02 ± 0.58\u003c\/td\u003e\n    \u003ctd\u003e1.03 ± 0.51\u003c\/td\u003e\n    \u003ctd\u003e0.98 ± 0.47\u003c\/td\u003e\n    \u003ctd\u003e0.08\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003e\u003cstrong\u003eTotal score\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e12.50 ± 4.16\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e12.10 ± 3.36\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e9.47 ± 3.70*\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c\/strong\u003e\u003c\/td\u003e\n  \u003c\/tr\u003e\n\u003c\/table\u003e\n\n\u003cp\u003e\u003cem\u003eScores: \"0 = never,\" \"1 = rarely,\" \"2 = sometimes,\" \"3 = most of the time,\" \"4 = all the time.\" Lower scores mean fewer symptoms. An asterisk (*) marks changes the authors judged clinically significant using the ERES method.\u003c\/em\u003e\u003c\/p\u003e\n\n\u003cp\u003eTwo patterns stand out. \u003cstrong\u003eConstipation improved significantly just 2 weeks after surgery\u003c\/strong\u003e and stayed improved at 6 weeks. \u003cstrong\u003eDiarrhea temporarily worsened at 2 weeks\u003c\/strong\u003e before improving again by 6 weeks. Abdominal pain, bloating, and nausea all improved significantly over the 6-week follow-up (p \u0026lt; 0.001 for each).\u003c\/p\u003e\n\n\u003cp\u003eThe total GIQLI score dropped from 12.50 before surgery to 9.47 at 6 weeks — a change of more than 3 points, which reflects a meaningful improvement in overall digestive well-being.\u003c\/p\u003e\n\n\u003ch3\u003ePersistent Symptoms at 6 Weeks\u003c\/h3\u003e\n\n\u003cp\u003eThe researchers then looked at how many patients still had significant symptoms at 6 weeks, defined as a GIQLI score of 3 or higher (\"most of the time\" or \"all the time\"). The numbers were low:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eDiarrhea: 8 patients (7.2%)\u003c\/li\u003e\n  \u003cli\u003eFrequent bowel movements: 7 patients (6.3%)\u003c\/li\u003e\n  \u003cli\u003eUrgent bowel movements: 6 patients (5.4%)\u003c\/li\u003e\n  \u003cli\u003eConstipation: 4 patients (3.6%)\u003c\/li\u003e\n  \u003cli\u003eAbdominal pain: 3 patients (2.7%)\u003c\/li\u003e\n  \u003cli\u003eBloating: 2 patients (1.8%)\u003c\/li\u003e\n  \u003cli\u003eNausea: 1 patient (0.9%)\u003c\/li\u003e\n  \u003cli\u003eUncontrolled stools: 1 patient (0.9%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eExpressed in \"X in Y\" terms, roughly 1 in 14 patients still reported frequent diarrhea at 6 weeks, about 1 in 16 reported frequent bowel movements, and about 1 in 18 reported urgency. Constipation affected about 1 in 28 patients, and pain and bloating each affected fewer than 1 in 35.\u003c\/p\u003e\n\n\u003ch2 id=\"cr29\"\u003eQuality of Life Results: The Cancer-Specific Questionnaire\u003c\/h2\u003e\n\n\u003cp\u003eThe EORTC QLQ-CR29 questionnaire was completed by 148 patients (93.7%) before surgery, 135 patients (85.4%) at 3 months, and 102 patients (64.5%) at 6 months. The drop-out rate was 35.4%. Again, only patients who completed the full follow-up were analyzed.\u003c\/p\u003e\n\n\u003cp\u003eA significant improvement in symptoms between baseline and follow-up was recorded for every item except gas and fecal incontinence.\u003c\/p\u003e\n\n\u003ctable\u003e\n  \u003ctr\u003e\n    \u003cth\u003eSymptom (QLQ-CR29 question)\u003c\/th\u003e\n    \u003cth\u003eBefore surgery\u003c\/th\u003e\n    \u003cth\u003e3 months after\u003c\/th\u003e\n    \u003cth\u003e6 months after\u003c\/th\u003e\n    \u003cth\u003ep value\u003c\/th\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eAbdominal pain (#35)\u003c\/td\u003e\n    \u003ctd\u003e1.73 ± 0.85\u003c\/td\u003e\n    \u003ctd\u003e1.50 ± 0.68*\u003c\/td\u003e\n    \u003ctd\u003e1.35 ± 0.64*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eBloated feeling in the abdomen (#37)\u003c\/td\u003e\n    \u003ctd\u003e2.04 ± 0.87\u003c\/td\u003e\n    \u003ctd\u003e1.64 ± 0.79*\u003c\/td\u003e\n    \u003ctd\u003e1.47 ± 0.71*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eUnintentional gas release \/ flatulence (#49)\u003c\/td\u003e\n    \u003ctd\u003e1.49 ± 0.83\u003c\/td\u003e\n    \u003ctd\u003e1.49 ± 0.81\u003c\/td\u003e\n    \u003ctd\u003e1.49 ± 0.78\u003c\/td\u003e\n    \u003ctd\u003e0.17\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eStool leakage from the back passage (#50)\u003c\/td\u003e\n    \u003ctd\u003e1.16 ± 0.54\u003c\/td\u003e\n    \u003ctd\u003e1.14 ± 0.52\u003c\/td\u003e\n    \u003ctd\u003e1.17 ± 0.51\u003c\/td\u003e\n    \u003ctd\u003e0.63\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eFrequent bowel movements during the day (#52)\u003c\/td\u003e\n    \u003ctd\u003e1.88 ± 0.89\u003c\/td\u003e\n    \u003ctd\u003e1.76 ± 0.83\u003c\/td\u003e\n    \u003ctd\u003e1.57 ± 0.70*\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003eFrequent bowel movements during the night (#53)\u003c\/td\u003e\n    \u003ctd\u003e1.44 ± 0.69\u003c\/td\u003e\n    \u003ctd\u003e1.27 ± 0.62\u003c\/td\u003e\n    \u003ctd\u003e1.22 ± 0.52\u003c\/td\u003e\n    \u003ctd\u003e\u0026lt; 0.001\u003c\/td\u003e\n  \u003c\/tr\u003e\n  \u003ctr\u003e\n    \u003ctd\u003e\u003cstrong\u003eTotal score\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e9.73 ± 3.05\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e8.80 ± 2.88\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e8.28 ± 2.65\u003c\/strong\u003e\u003c\/td\u003e\n    \u003ctd\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c\/strong\u003e\u003c\/td\u003e\n  \u003c\/tr\u003e\n\u003c\/table\u003e\n\n\u003cp\u003e\u003cem\u003eScores: \"1 = never,\" \"2 = occasionally,\" \"3 = most of the time,\" \"4 = all the time.\" Lower scores mean fewer symptoms. An asterisk (*) marks clinically significant changes by the ERES method.\u003c\/em\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe total score improved significantly across the 6-month follow-up period (p \u0026lt; 0.001), falling from 9.73 before surgery to 8.28 at 6 months.\u003c\/p\u003e\n\n\u003ch3\u003ePersistent Symptoms at 6 Months\u003c\/h3\u003e\n\n\u003cp\u003eUsing the same \"3 or higher\" threshold at 6 months after surgery, the rates of lasting symptoms were:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eUnintentional gas release (flatulence): 13 patients (12.7%) — about 1 in 8\u003c\/li\u003e\n  \u003cli\u003eBloating: 9 patients (8.8%) — about 1 in 11\u003c\/li\u003e\n  \u003cli\u003eFrequent bowel movements during the day: 8 patients (7.8%) — about 1 in 13\u003c\/li\u003e\n  \u003cli\u003eAbdominal pain: 5 patients (4.9%) — about 1 in 20\u003c\/li\u003e\n  \u003cli\u003eStool leakage: 4 patients (3.9%) — about 1 in 26\u003c\/li\u003e\n  \u003cli\u003eFrequent bowel movements during the night: 3 patients (2.9%) — about 1 in 34\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eNotably, gas and stool leakage were the two items that did not improve over time — they stayed roughly the same from before surgery through 6 months afterward.\u003c\/p\u003e\n\n\u003ch2 id=\"predictors\"\u003eWhich Patients Had More Lasting Symptoms?\u003c\/h2\u003e\n\n\u003cp\u003eThe linear mixed-effects model identified several factors linked to worse symptom scores. This type of analysis accounts for repeated measurements over time and adjusts for other variables.\u003c\/p\u003e\n\n\u003cp\u003eWhen using the GIQLI questionnaire, the following associations were found 6 weeks after surgery:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFemale gender\u003c\/strong\u003e was linked to more frequent abdominal pain, bloating, frequent bowel movements, diarrhea, and nausea.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced age\u003c\/strong\u003e and \u003cstrong\u003eopen surgery\u003c\/strong\u003e were linked to constipation.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced AJCC cancer stage\u003c\/strong\u003e at the time of surgery was related to postoperative abdominal pain, bloating, frequent bowel movements, and urgent bowel movements.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLonger surgical specimen\u003c\/strong\u003e (the total piece removed) correlated with bloating, frequent bowel movements, and urgent bowel movements.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eLooking specifically at the GIQLI total score at 6 weeks, worsening quality of life was significantly correlated with \u003cstrong\u003efemale gender (p = 0.03)\u003c\/strong\u003e and with the \u003cstrong\u003elength of ileum removed (p = 0.04)\u003c\/strong\u003e. These associations were statistically significant, meaning they are unlikely to be explained by chance alone.\u003c\/p\u003e\n\n\u003cp\u003eWhen using the EORTC QLQ-CR29 questionnaire, the following associations were found 6 months after surgery:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFemale gender\u003c\/strong\u003e affected the frequency of bowel movements.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced age\u003c\/strong\u003e was linked to stool leakage.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOpen surgical approach\u003c\/strong\u003e correlated with postoperative abdominal pain, gas incontinence, and stool leakage.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced AJCC cancer stage\u003c\/strong\u003e was related to abdominal pain, bloating, and frequent bowel movements during the day.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLonger specimen length\u003c\/strong\u003e correlated with gas incontinence, stool leakage, and frequent bowel movements during the day.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003ePut simply: some patients tended to report more lingering symptoms. These were patients who were female, older, had open rather than keyhole surgery, had more advanced cancer, or had a longer segment of bowel removed. The authors emphasize that these are associations, not proof of cause and effect.\u003c\/p\u003e\n\n\u003ch2 id=\"b12\"\u003eVitamin B12 Levels After Surgery\u003c\/h2\u003e\n\n\u003cp\u003eBlood samples for vitamin B12 were collected before surgery, at 3 months, and at 6 months. Complete 6-month data were available for 92 patients (58.2%), and only these patients were included in the statistical analysis.\u003c\/p\u003e\n\n\u003cp\u003eThe baseline median vitamin B12 level was \u003cstrong\u003e307.0 pg\/mL\u003c\/strong\u003e (range 81.9–2295.2 pg\/mL). At 3 months the median was \u003cstrong\u003e287.0 pg\/mL\u003c\/strong\u003e (range 76.0–1394.0 pg\/mL), and at 6 months it was \u003cstrong\u003e294.0 pg\/mL\u003c\/strong\u003e (range 73.8–892.3 pg\/mL).\u003c\/p\u003e\n\n\u003cp\u003eThe overall longitudinal analysis showed a small but statistically significant decrease over time (p \u0026lt; 0.001). Importantly, these median values all stayed within the normal reference range of 148 pg\/mL to 980 pg\/mL, and \u003cstrong\u003eno significant deficiency was observed regardless of the length of the surgical specimen\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eThe team then split patients by how much ileum was removed. Two very different patterns emerged:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatients with 20 cm or more of ileum removed\u003c\/strong\u003e showed a significant decrease in vitamin B12 levels that was already visible at 3 months:\n    \u003cul\u003e\n      \u003cli\u003eBefore surgery: median 376.0 pg\/mL (range 185.0–631.0 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003e3 months after: median 372.0 pg\/mL (range 207.0–596.0 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003e6 months after: median 325.0 pg\/mL (range 131.0–564.0 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003ep \u0026lt; 0.001\u003c\/li\u003e\n    \u003c\/ul\u003e\n  \u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatients with less than 20 cm of ileum removed\u003c\/strong\u003e actually showed a small but statistically significant \u003cem\u003eincrease\u003c\/em\u003e in vitamin B12 levels at 6 months compared with before surgery:\n    \u003cul\u003e\n      \u003cli\u003eBefore surgery: median 240.0 pg\/mL (range 81.9–2295.2 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003e3 months after: median 255.5 pg\/mL (range 76.0–1394.0 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003e6 months after: median 265.0 pg\/mL (range 73.8–892.3 pg\/mL)\u003c\/li\u003e\n      \u003cli\u003ep = 0.02\u003c\/li\u003e\n    \u003c\/ul\u003e\n  \u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThis finding fits with what is known about vitamin B12 absorption. The vitamin is actively absorbed in the terminal ileum, but a small amount is passively absorbed throughout the entire small bowel. When less than 20 cm of ileum is removed, that passive absorption appears to compensate.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat These Findings Mean for Patients\u003c\/h2\u003e\n\n\u003cp\u003eAfter removal of the ileocecal valve, patients can experience changes in bowel habits. These changes vary widely from person to person. Researchers believe they may be related to small bowel bacterial overgrowth (SIBO).\u003c\/p\u003e\n\n\u003cp\u003eIn most cases, bowel function after ileocecal valve removal is reported as satisfactory. That is what this study found too. The overall picture was reassuring: quality of life improved, and vitamin B12 levels did not fall into a deficient range.\u003c\/p\u003e\n\n\u003cp\u003eHowever, the authors are clear that a significant postoperative dysfunction can sometimes occur. When it does, it can affect general well-being and health-related quality of life. In rare cases, the authors note, it can even become a potential cause for medical-legal issues — which is one reason they emphasize the importance of informing patients in advance.\u003c\/p\u003e\n\n\u003cp\u003eThe authors also reference guidance from the Italian Society of Legal Medicine and Insurance Policy (SIMLA). This underscores that the duty to warn patients about possible bowel habit changes is not just good practice but a recognized professional obligation.\u003c\/p\u003e\n\n\u003cp\u003eSeveral specific takeaways stand out for patients:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMost symptoms improve, not worsen.\u003c\/strong\u003e Abdominal pain, bloating, nausea, constipation, and both daytime and nighttime bowel frequency all improved significantly after surgery.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDiarrhea may briefly get worse.\u003c\/strong\u003e Diarrhea scores worsened at 2 weeks after surgery before improving by 6 weeks. Patients should expect a temporary phase, not assume the problem is permanent.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eGas and stool leakage may not improve.\u003c\/strong\u003e These were the two items that stayed stable rather than improving.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eVitamin B12 deficiency was not a problem in this group\u003c\/strong\u003e — even among patients who had 20 cm or more of ileum removed. However, those patients did show a measurable downward trend, so monitoring may still be reasonable.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSome patients are more likely to have lingering symptoms:\u003c\/strong\u003e women, older patients, those who had open surgery, those with more advanced cancer stage, and those with longer bowel segments removed.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIt is important to note what the study does not show. It does not prove that any of these factors cause worse symptoms. It also cannot say whether symptoms would have been better or worse without surgery, because there was no comparison group of patients who did not have the operation.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of the Study\u003c\/h2\u003e\n\n\u003cp\u003eThe authors are transparent about the study's constraints. Understanding these helps patients interpret the results correctly.\u003c\/p\u003e\n\n\u003cp\u003eFirst, the follow-up periods were relatively short — 6 weeks for the GIQLI and 6 months for the EORTC QLQ-CR29. Longer-term outcomes beyond 6 months are not captured here.\u003c\/p\u003e\n\n\u003cp\u003eSecond, drop-out rates were substantial. The GIQLI had a 29.7% drop-out rate, and the QLQ-CR29 had a 35.4% drop-out rate. Vitamin B12 data at 6 months were available for only 92 patients (58.2%). Patients who dropped out may have had different outcomes than those who stayed in the study, which could bias results in either direction.\u003c\/p\u003e\n\n\u003cp\u003eThird, the patient population was heavily weighted toward cancer surgery. In total, 149 of 158 patients (93.3%) had malignant disease. Only 9 patients (6.7%) had benign disease, and only 3 patients (1.9%) underwent ileocecal resection specifically. This means the findings apply most confidently to patients having surgery for colon cancer, and less so to other groups.\u003c\/p\u003e\n\n\u003cp\u003eFourth, very few patients had laparoscopic surgery converted to robotic surgery (just 1 patient, 0.6%), so no conclusions can be drawn about robotic approaches.\u003c\/p\u003e\n\n\u003cp\u003eFifth, the study was observational — patients were not randomly assigned to different operations. Therefore, comparisons between surgical approaches (open vs. laparoscopic) may be influenced by why the surgeon chose that approach in the first place.\u003c\/p\u003e\n\n\u003cp\u003eFinally, the statistical analysis relied on patients who completed follow-up, which reduces the sample size and the strength of the conclusions.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003ePractical Recommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on this study and the authors' conclusions, here is what patients can reasonably expect and do:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eExpect a recovery curve, not an immediate result.\u003c\/strong\u003e Bowel symptoms generally improve over weeks to months. Give your body time.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not be alarmed by early diarrhea.\u003c\/strong\u003e Diarrhea commonly worsens in the first 2 weeks after surgery and then improves. Stay hydrated and discuss persistent diarrhea with your surgeon.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about vitamin B12 monitoring if a longer segment of ileum was removed.\u003c\/strong\u003e In this study, patients who had 20 cm or more of ileum removed showed a downward trend in vitamin B12 levels, even though no one became deficient. A simple blood test at 3 and 6 months after surgery can track this.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow your own risk profile.\u003c\/strong\u003e You may be more likely to notice lasting symptoms if you are female or older. You may be more likely to notice lasting symptoms if you had open surgery. You may be more likely to notice lasting symptoms if you have a more advanced cancer stage. You may be more likely to notice lasting symptoms if you had a long segment of bowel removed. This does not mean symptoms are inevitable — only that they are more likely.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDiscuss bowel habit changes openly with your care team.\u003c\/strong\u003e The authors stress that warning patients about potential bowel habit changes is mandatory. If you were not told what to expect, ask.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSeek help for persistent symptoms.\u003c\/strong\u003e If gas incontinence, stool leakage, or frequent bowel movements last more than a few months, ask about evaluation for small intestinal bacterial overgrowth (SIBO). SIBO affects up to 32% of patients after ileocecal valve removal.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKeep perspective.\u003c\/strong\u003e In this study of 158 patients, health-related quality of life improved overall, and no vitamin B12 deficiency developed. Most patients did well.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is the ileocecal valve, and why does removing it matter?\u003c\/h3\u003e\n\u003cp\u003eThe ileocecal valve is a muscular ring that separates the small bowel from the large bowel and controls how digested food passes through. When surgeons remove it during right colectomy or ileocecal resection, bacteria from the colon can move backward into the ileum. This backward movement can lead to a condition called small intestinal bacterial overgrowth, or SIBO.\u003c\/p\u003e\n\u003ch3\u003eWill my bowel habits get worse after this surgery?\u003c\/h3\u003e\n\u003cp\u003eIn a study of 158 patients, most bowel symptoms improved over six months. Abdominal pain, bloating, nausea, constipation, and frequent bowel movements all got better. Diarrhea briefly worsened at two weeks before improving by six weeks. Gas and stool leakage stayed about the same. A small number of patients reported lasting symptoms, so some change is possible.\u003c\/p\u003e\n\u003ch3\u003eWhich patients are more likely to have lasting bowel symptoms?\u003c\/h3\u003e\n\u003cp\u003eThe study found that several groups reported more persistent symptoms. These groups were women, older patients, those who had open surgery rather than keyhole surgery, those with more advanced cancer stage, and those with a longer segment of bowel removed. These are associations, not proof of cause and effect. Knowing your risk profile can help you discuss symptoms openly with your care team.\u003c\/p\u003e\n\u003ch3\u003eHow long does recovery take, and what should I expect?\u003c\/h3\u003e\n\u003cp\u003eExpect a recovery curve, not an immediate result. Bowel symptoms generally improve over weeks to months. Diarrhea commonly worsens in the first two weeks after surgery and then improves. Give your body time, stay hydrated, and discuss persistent diarrhea with your surgeon. If gas incontinence, stool leakage, or frequent bowel movements last more than a few months, ask about evaluation for SIBO.\u003c\/p\u003e\n\u003ch3\u003eWhat is SIBO, and how common is it after ileocecal valve removal?\u003c\/h3\u003e\n\u003cp\u003eSIBO stands for small intestinal bacterial overgrowth, meaning too many bacteria grow in the upper part of the gut. Symptoms are usually vague and may include abdominal discomfort, bloating, and diarrhea. In the general population, reported prevalence ranges from 0% to 20%. After removal of the ileocecal valve, that number rises to as much as 32%.\u003c\/p\u003e\n\u003ch3\u003eIf I'm scheduled for a right colectomy that removes my ileocecal valve, when should I get a second opinion?\u003c\/h3\u003e\n\u003cp\u003eA second opinion is reasonable before surgery if you want confirmation that removing the ileocecal valve is necessary and whether alternatives exist. Bowel symptoms such as pain, bloating, nausea, constipation and bowel frequency generally improve after surgery, though diarrhea briefly worsens, and gas and stool leakage may persist. Women, older patients, those having open surgery, more advanced cancer stages, and longer bowel segments removed report more lasting symptoms. A second opinion can review your pathology, imaging and planned operation. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Ileocecal valve syndrome and vitamin b12 deficiency after surgery\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Paola Germani, Annalisa Zucca, Fabiola Giudici, Susanna Terranova, Marina Troian, Natasa Samardzic, Marco Greco, Jurij Janez, Camilla Gasparini, Emanuela Cagnazzo, Andrea Vignali, Fabio Giannone Codiglione, Andrea Armellini, Uberto Romario Fumagalli, Riccardo Rosati, Giuseppe Piccinni, Jacques Megevand, Ales Tomazic, Francesco Corcione, Silvia Palmisano, and Nicolò de Manzini\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eParticipating institutions:\u003c\/strong\u003e University Hospital of Trieste (Trieste, Italy); Monaldi Hospital, Azienda Ospedaliera Dei Colli (Naples, Italy); Ljubljana University Medical Center (Ljubljana, Slovenia); San Pio X Humanitas Research Hospital (Milan, Italy); Santa Maria Hospital GVM Care and Research (Bari, Italy); San Raffaele Hospital, Vita-Salute San Raffaele University (Milan, Italy); and Ospedali Civili (Brescia, Italy)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e \u003cem\u003eUpdates in Surgery\u003c\/em\u003e, 2021, Volume 73, pages 569–580. Published online 9 July 2020. DOI: 10.1007\/s13304-020-00845-z. Received 9 May 2020; accepted 1 July 2020.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c\/strong\u003e Protocol Number 5903, Local Ethical Committee of Trieste University Hospital. Written informed consent was obtained from all participants.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eKey terms used in this article:\u003c\/strong\u003e ileocecal valve (the muscular valve between the small and large bowel); SIBO or small intestinal bacterial overgrowth (too many bacteria in the upper gut); GIQLI (Gastrointestinal Quality of Life questionnaire); EORTC QLQ-CR29 (European Organization for Research and Treatment of Cancer colorectal cancer quality-of-life questionnaire); HRQL (health-related quality of life); LME model (linear mixed-effects model); ERES (empirical rule effect-size); AJCC (American Joint Committee on Cancer staging system); Clavien-Dindo classification (a standard scale for surgical complications).\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47545209421980,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-life-after-ileocecal-valve-removal-how-bowel-function-quality-of-life-and-vitamin-b12-levels-are-affected-hero.png?v=1790155946","url":"https:\/\/diagnosticdetectives.com\/he\/products\/life-after-ileocecal-valve-removal-how-bowel-function-quality-of-life-and-vitamin-b12-levels-are-affected","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}