Martinek L, You K, Giuratrabocchetta S, Gachabayov M, Lee K, Bergamaschi R
Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
Division of Colorectal surgery, State University of New York, Stony Brook, NY, USA.
Int J Colorectal Dis. 2018 Mar;33(3):291-298. doi: 10.1007/s00384-017-2957-7. Epub 2018 Jan 11.
Foreshortened mesentery or thick abdominal wall constitutes a rationale for laparoscopic intracorporeal ileocolic anastomoses (ICA). The aim of this study was to compare intracorporeal to extracorporeal ICA in terms of surgical site infections in patients with Crohn's ileitis and overweight patients with right colon tumors.
This was a prospective propensity score-matched cohort study enrolling consecutive patients with Crohn's terminal ileitis and overweight patients with right colon tumors undergoing elective laparoscopic right colon resection with intracorporeal or extracorporeal ICA. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, BMI, ASA, and previous abdominal surgery.
Overall, 453 patients were enrolled: 233 intracorporeal vs. 220 extracorporeal. Propensity score matching left 195 intracorporeal and 195 extracorporeal patients comparable for age (p = 0.294), gender (p = 0.683), ASA (p = 0.545), BMI (p = 0.079), previous abdominal surgery (p = 0.348), and diagnosis (p = 0.301). Conversion rates (5.1 vs. 3.6%; p = 0.457) and intraoperative complications (1 vs. 2.1%; p = 0.45) were similar. Overall morbidity (5.1 vs. 12.8%; p = 0.008) and re-intervention rates (3.1 vs. 8.7%; p = 0.029) were significantly higher in extracorporeal patients. Anastomotic leak rates (0.5 vs. 1.5%; p = 0.623) did not differ. Incisional SSI rate was significantly higher in extracorporeal patients (p = 0.01).
Laparoscopic intracorporeal ICA reduced incisional SSI rates as compared to its extracorporeal counterpart.
肠系膜缩短或腹壁增厚是腹腔镜体内回结肠吻合术（ICA）的一个理论依据。本研究的目的是比较克罗恩回肠炎患者和超重右半结肠癌患者体内ICA与体外ICA的手术部位感染情况。
这是一项前瞻性倾向评分匹配队列研究，纳入连续的克罗恩末段回肠炎患者和超重右半结肠癌患者，他们接受择期腹腔镜右半结肠切除术并进行体内或体外ICA。采用1:1比例的倾向评分匹配来比较年龄、体重指数（BMI）、美国麻醉医师协会（ASA）分级和既往腹部手术情况相匹配的诊断患者。
总体而言，共纳入453例患者：233例接受体内ICA，220例接受体外ICA。倾向评分匹配后，195例体内ICA患者和195例体外ICA患者在年龄（p = 0.294）、性别（p = 0.683）、ASA分级（p = 0.545）、BMI（p = 0.079）、既往腹部手术（p = 0.348）和诊断（p = 0.301）方面具有可比性。转换率（5.1%对3.6%；p = 0.457）和术中并发症（1%对2.1%；p = 0.45）相似。体外ICA患者的总体发病率（5.1%对12.8%；p = 0.008）和再次干预率（3.1%对8.7%；p = 0.029）显著更高。吻合口漏率（0.5%对1.5%；p = 0.623）无差异。体外ICA患者的切口手术部位感染率显著更高（p = 0.01）。
与体外ICA相比，腹腔镜体内ICA降低了切口手术部位感染率。
