Luigi Sacco University Hospital, Department of Oncology, Gastroenterology and Surgery-University of Milan, Italy.
Unit of Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Università Della Campania "Luigi Vanvitelli", Naples, Italy.
Am J Surg. 2019 Apr;217(4):682-688. doi: 10.1016/j.amjsurg.2018.07.028. Epub 2018 Jul 24.
Although the creation of a stoma reduces the risk of septic pouch complications following ileal pouch-anal anastomosis (IPAA), the stoma itself and its reversal can give rise to substantial morbidity during the two- or three-stage concept. Aim of study is to compare stoma-related complications in Ulcerative Colitis patients undergoing laparoscopic versus open IPAA.
We collected data on 250 IPAA patients from two Italian Centres between 2005 and 2015. We compared perioperative and postoperative events in 150 open vs 100 laparoscopic IPAA. We performed a case-matched analysis based on baseline differences among groups to compare the rate of mechanical complications.
There were no significant differences between open and laparoscopic IPAA in overall stoma complications (complications during ileostomy: 11.3% vs 12%,p = 0.8; early complications: 10% vs 8%,p = 0.5; late complications: 12.6% vs 6%,p = 0.08). The case-matched analysis found a slightly reduced incidence of obstructive complications at any stage with laparoscopy.
Overall stoma related complications do not seem to be reduced by minimally-invasive approach itself, but patients might experience less mechanical problems with laparoscopy without conversion.
尽管造口术降低了回肠贮袋肛管吻合术（IPAA）后感染性贮袋并发症的风险，但造口本身及其逆转在两阶段或三阶段概念中会引起相当大的发病率。本研究的目的是比较腹腔镜与开腹 IPAA 治疗溃疡性结肠炎患者的与造口相关的并发症。
我们收集了 2005 年至 2015 年间意大利两个中心的 250 例 IPAA 患者的数据。我们比较了 150 例开腹与 100 例腹腔镜 IPAA 的围手术期和术后事件。我们根据组间基线差异进行病例匹配分析，以比较机械并发症的发生率。
开腹和腹腔镜 IPAA 在总体造口并发症方面无显著差异（造口期间并发症：11.3% vs 12%，p=0.8；早期并发症：10% vs 8%，p=0.5；晚期并发症：12.6% vs 6%，p=0.08）。病例匹配分析发现腹腔镜手术可降低任何阶段的梗阻性并发症发生率。
微创方法本身似乎并不能降低与造口相关的总体并发症，但患者可能会经历更少的机械问题，而无需转为开腹。
