The impact of colectomy and restorative procedure on pouch function after ileo-pouch-anal anastomosis in ulcerative colitis. The icon fun study on behalf of the Italian Society of Colon and Rectal Surgery (SICCR) Inflammatory Bowel Diseases committee.

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-10-08 DOI:10.1016/j.dld.2024.09.013
Michela Mineccia, Alessandro Ferrero, Matteo Rottoli, Antonino Spinelli, Luigi Sofo, Giampaolo Ugolini, Giuliano Barugola, Giacomo Ruffo, Andrea Braini, Gaetano Luglio, Giuseppe Sica, Gianluca M Sampietro
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Abstract

Background: Available guidelines lack in indications on surgical standard in Ulcerative Colitis (UC) AIMS: To determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. The secondary aims consisted of perioperative outcomes and complications.

Methods: Data on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological Low-Anterior-Resection-Syndrome (LARS) score.

Results: Mesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. Laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). Mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). Hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). The Transanal-Transection and Single-Stapling Anastomosis (TTSS) showed to be protective against pouchitis. Extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057).

Conclusions: The study highlights advantages of laparoscopy. New techniques such as TTSS promise further improvements. Mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.

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溃疡性结肠炎患者回肠袋-肛门吻合术后,结肠切除术和修复术对肠袋功能的影响。代表意大利结肠直肠外科协会(SICCR)炎症性肠病委员会进行的图标趣味研究。
背景:目的:在一项全国范围的多中心研究中,确定结肠切除术和直肠切除术加肠袋-肛门-吻合术(IPAA)的手术策略对功能预后的作用。次要目的包括围手术期结果和并发症:在红帽多中心数据库中回顾性收集了379名接受全腹结肠切除术和直肠切除术并行回肠-肛门-肛门吻合术(IPAA)、回肠造口分流或不分流的患者的数据,搜索可能影响肛门袋术后效果的变量,如袖状囊炎、肛门袋炎、吻合口狭窄、肛门袋狭窄、失败或病理低前切口综合征(LARS)评分:结果:中结肠剥离术在主要主干和从内侧到外侧封堵血管的效果较好。腹腔镜手术与较低的袖口炎发生率有关(P = 0.028)。肠系膜延长术与较高的肠袋炎发生率(p = 0.015)和较早的失败率(p < 0.0001)有关。手缝 IPAA 会导致早期吻合口狭窄(p = 0.00011)。经肛门横切和单缝吻合术(TTSS)可预防肠袋炎。扩大粘连剥离与较低的胃袋炎发作率相关(p = 0.0057):本研究强调了腹腔镜手术的优势。结论:该研究强调了腹腔镜手术的优势,TTSS 等新技术有望进一步提高手术效果。肠系膜延长术与肠袋失败和肠袋炎的高风险相关,手缝吻合术增加了肠袋狭窄的风险。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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