Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
Division of Colorectal Surgery, University Hospitals, Cleveland, Ohio.
Dis Colon Rectum. 2018 May;61(5):573-578. doi: 10.1097/DCR.0000000000001052.
A laparoscopic approach to total proctocolectomy with IPAA has been suggested to have better short-term outcomes and cosmesis, whereas open surgery by midline incision may result in shorter operative times. We hypothesized that a modified Pfannenstiel open approach would combine the advantages of both techniques.
The purpose of this study was to compare outcomes of open total proctocolectomy with IPAA using a modified Pfannenstiel incision versus those following the laparoscopic approach.
This was a retrospective study comparing patients submitted to open IPAA using modified Pfannenstiel incision versus laparoscopy from 1998 to 2014.
The study was conducted at a high-volume tertiary referral center.
Among 1275 patients, 119 patients underwent the laparoscopic approach and 33 underwent the modified Pfannenstiel approach.
Short- and long-term outcomes were evaluated, and quality-of-life questionnaires were assessed.
Patients who underwent the modified Pfannenstiel approach were younger, more often women, and had lower BMI and ASA classification compared with those who underwent laparoscopy. Surgical time was lower in Pfannenstiel, and no difference was observed in length of hospital stay. No difference was observed in postoperative complications, pouch failure rate, or quality of life. Patients were then matched 1:1 by diagnosis, sex, age (±5 y) and BMI (±5 kg/m). The Pfannenstiel approach still had a shorter surgical time. No difference was observed in the length of hospital stay, complications, pouch failure, or quality of life. In long-term follow-up, pouchitis symptoms occurred more frequently in Pfannenstiel (mean follow-up = 7.3 y), and seepage was more frequently observed in the laparoscopy group (mean follow-up = 4.2 y). These differences were not observed in matched patients.
The study was limited by its retrospective design and inherent selection bias.
The modified Pfannenstiel approach provides equivalent short- and long-term outcomes and similar quality of life compared with laparoscopy but with a significantly shorter operative time. The modified Pfannenstiel approach to total proctocolectomy with IPAA may be the most efficient method in selected patients. See Video Abstract at http://links.lww.com/DCR/A562.
腹腔镜全直肠结肠切除术（total proctocolectomy with IPAA）联合回肠储袋肛管吻合术（ileal pouch anal anastomosis，IPAA）具有更好的短期疗效和美容效果，而经中线切口的开放手术可能会缩短手术时间。我们假设改良的经腹Pfannenstiel 入路可以结合这两种技术的优点。
本研究旨在比较改良Pfannenstiel 切口开腹全直肠结肠切除术（total proctocolectomy with IPAA）与腹腔镜手术的疗效。
这是一项回顾性研究，比较了 1998 年至 2014 年间采用改良 Pfannenstiel 切口与腹腔镜进行开腹 IPAA 的患者。
这项研究在一个高容量的三级转诊中心进行。
1275 例患者中，119 例行腹腔镜手术，33 例行改良 Pfannenstiel 入路手术。
评估短期和长期疗效，并评估生活质量问卷。
与腹腔镜组相比，改良 Pfannenstiel 组患者更年轻，女性更多，体重指数（body mass index，BMI）和美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级更低。Pfannenstiel 组的手术时间更短，住院时间无差异。术后并发症、储袋失败率和生活质量无差异。然后，通过诊断、性别、年龄（±5 岁）和 BMI（±5kg/m²）对患者进行 1:1 匹配。Pfannenstiel 组的手术时间仍然较短。住院时间、并发症、储袋失败和生活质量无差异。在长期随访中，Pfannenstiel 组的储袋炎症状更为常见（平均随访时间=7.3 年），而腹腔镜组的渗漏更为常见（平均随访时间=4.2 年）。在匹配患者中未观察到这些差异。
本研究受限于回顾性设计和固有选择偏倚。
改良 Pfannenstiel 入路与腹腔镜相比具有相同的短期和长期疗效及相似的生活质量，但手术时间明显缩短。改良 Pfannenstiel 入路联合 IPAA 治疗全直肠结肠切除术可能是一种在特定患者中最有效的方法。视频摘要请访问：http://links.lww.com/DCR/A562。
