Bertoni Danielle M, Hammond Kerry L, Beck David E, Hicks Terry C, Whitlow Charles B, Vargas H David, Margolin David A
Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA.
Section of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC.
Ochsner J. 2017 Summer;17(2):146-149.
Loop ileostomy is a common adjunct to surgical procedures for low rectal cancers and inflammatory bowel disease. Ileostomy closure through a limited incision can be technically challenging. We hypothesized that placing a sodium hyaluronate/carboxymethylcellulose (SH/CMC) bioresorbable membrane at loop ileostomy creation would decrease stoma closure time without increasing morbidity.
In a retrospective review at a single institution with 6 board-certified colorectal surgeons, patients with loop ileostomy creation and closure between September 1999 and December 2011 were grouped based on SH/CMC placement at ileostomy creation. Data were abstracted for age, sex, body mass index (BMI), primary diagnosis, length of surgery, staff surgeon, interval between surgeries, and postoperative morbidity. The primary endpoint was the length of the surgery for ileostomy closure. Secondary outcome measures were length of stay, wound infection rate, and other complications.
A total of 293 patients were identified. Group 1 (with SH/CMC) included 146 patients, and Group 2 (without SH/CMC) included 147 patients. The groups were matched according to age, sex, BMI, interval between creation and closure, and indication for surgery. The average surgical time for closure was significantly shorter in Group 1 (46.4 minutes ± 2.7) compared to Group 2 (60 minutes ± 2.3) (=0.0001). We found no difference between the groups in length of stay, wound infection rate, or complication rate.
The use of SH/CMC in loop ileostomy creation significantly decreases the operative time required for stoma closure with no increase in the complication rate.
袢式回肠造口术是低位直肠癌和炎症性肠病手术的常见辅助手段。通过有限切口关闭回肠造口术在技术上具有挑战性。我们推测，在创建袢式回肠造口术时放置透明质酸钠/羧甲基纤维素（SH/CMC）生物可吸收膜可缩短造口关闭时间且不增加发病率。
在一家机构对6名获得委员会认证的结直肠外科医生进行的回顾性研究中，将1999年9月至2011年12月期间接受袢式回肠造口术创建和关闭的患者，根据造口创建时是否放置SH/CMC进行分组。提取患者的年龄、性别、体重指数（BMI）、初步诊断、手术时长、主刀医生、两次手术间隔时间以及术后发病率等数据。主要终点是回肠造口关闭手术的时长。次要观察指标包括住院时长、伤口感染率及其他并发症。
共确定293例患者。第1组（使用SH/CMC）有146例患者，第2组（未使用SH/CMC）有147例患者。两组在年龄、性别、BMI、造口创建与关闭的间隔时间以及手术指征方面相匹配。第1组关闭造口的平均手术时间（46.4分钟±2.7）明显短于第2组（60分钟±2.3）（P=0.0001）。我们发现两组在住院时长、伤口感染率或并发症发生率方面无差异。
在袢式回肠造口术创建中使用SH/CMC可显著缩短造口关闭所需的手术时间，且不增加并发症发生率。
