Benlice Cigdem, Stocchi Luca, Costedio Meagan, Gorgun Emre, Hull Tracy, Kessler Hermann, Remzi Feza H
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
Dis Colon Rectum. 2015 Mar;58(3):314-20. doi: 10.1097/DCR.0000000000000287.
There are scant data on the presumed reduction of small-bowel obstruction and incisional hernia rates associated with laparoscopic IPAA.
The aim of this study was to compare long-term outcomes after open vs laparoscopic IPAA based on a previous study from our institution.
This was a retrospective cohort study (from January 1992 through December 2007).
The study was conducted in a high-volume, specialized colorectal surgery department.
Patients included those who were enrolled in a previous institutional case-matched (2:1) study that examined 238 open and 119 laparoscopic IPAAs.
Long-term complications, including incisional hernia clinically detected by physician, adhesive small-bowel obstruction requiring hospital admission and surgery, pouch excision, and pouchitis rates, were collected. Laparoscopic abdominal colectomy followed by rectal dissection under direct vision (lower midline or Pfannenstiel incision) and converted cases were analyzed within the laparoscopic group.
Groups were comparable with respect to age, sex, BMI, and extent of resection (completion proctectomy vs proctocolectomy), consistent with the original case matching. Mean follow-up was significantly longer in the open group (9.6 vs 8.1 years; p = 0.008). Open and laparoscopic operations were associated with similar incidences of incisional hernia (8.4% vs 5.9%; p = 0.40), small-bowel obstruction requiring hospital admission (26.1% vs 29.4%; p = 0.50), and small-bowel obstruction requiring surgery (8.4% vs 11.8%; p = 0.31). A subgroup analysis comparing 50 patients with laparoscopic rectal dissection versus 69 patients with rectal dissection under direct vision confirmed statistically similar incidences of incisional hernia, hospital admission, and surgery for small-bowel obstruction.
This study was limited by its retrospective nature.
Some of the anticipated long-term benefits of laparoscopic IPAA could not be demonstrated in this cohort. The lack of such long-term benefits should be discussed with patients when proposing a laparoscopic approach.
关于腹腔镜回肠储袋肛管吻合术（IPAA）可能降低小肠梗阻和切口疝发生率的数据很少。
本研究旨在根据我们机构之前的一项研究，比较开放手术与腹腔镜IPAA术后的长期结局。
这是一项回顾性队列研究（1992年1月至2007年12月）。
该研究在一个高容量的专业结直肠外科进行。
患者包括那些参与之前机构病例匹配（2:1）研究的人，该研究检查了238例开放手术和119例腹腔镜IPAA手术。
收集长期并发症，包括医生临床检测到的切口疝、需要住院和手术的粘连性小肠梗阻、储袋切除和储袋炎发生率。腹腔镜组分析了腹腔镜下全腹结肠切除术，随后在直视下进行直肠分离（下中线或耻骨上切口）以及中转病例。
两组在年龄、性别、体重指数和切除范围（完成直肠切除术与全直肠结肠切除术）方面具有可比性，与最初的病例匹配一致。开放组的平均随访时间明显更长（9.6年对8.1年；p = 0.008）。开放手术和腹腔镜手术的切口疝发生率（8.4%对5.9%；p = 0.40）、需要住院的小肠梗阻发生率（26.1%对29.4%；p = 0.50）以及需要手术的小肠梗阻发生率（8.4%对11.8%；p = 0.31）相似。一项亚组分析比较了50例腹腔镜直肠分离患者与69例直视下直肠分离患者，结果证实切口疝、住院和小肠梗阻手术发生率在统计学上相似。
本研究受其回顾性性质的限制。
在该队列中未能证明腹腔镜IPAA一些预期的长期益处。在建议采用腹腔镜手术方法时，应与患者讨论缺乏此类长期益处的情况。
