P Tsarkov, S Barkhatov, D Shlyk, L Safyanov, V Balaban, M He
{"title":"骶前囊肿切除时直肠穿孔的危险因素：经腹、会阴和联合手术入路的比较。","authors":"P Tsarkov, S Barkhatov, D Shlyk, L Safyanov, V Balaban, M He","doi":"10.1007/s10151-024-03071-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts.</p><p><strong>Methods: </strong>This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software.</p><p><strong>Results: </strong>The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge.</p><p><strong>Conclusions: </strong>The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"23"},"PeriodicalIF":2.7000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factors for rectal perforation during presacral cyst removal: a comparison between transabdominal, perineal, and combined surgical approaches.\",\"authors\":\"P Tsarkov, S Barkhatov, D Shlyk, L Safyanov, V Balaban, M He\",\"doi\":\"10.1007/s10151-024-03071-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts.</p><p><strong>Methods: </strong>This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software.</p><p><strong>Results: </strong>The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge.</p><p><strong>Conclusions: </strong>The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"23\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-024-03071-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-024-03071-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Risk factors for rectal perforation during presacral cyst removal: a comparison between transabdominal, perineal, and combined surgical approaches.
Background: This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts.
Methods: This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software.
Results: The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge.
Conclusions: The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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