Division of Colon and Rectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song District, Kaohsiung 833, Taiwan.
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Song District, Kaohsiung 833, Taiwan.
Biomed Res Int. 2018 Sep 26;2018:9123912. doi: 10.1155/2018/9123912. eCollection 2018.
There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy.
A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4).
Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy.
This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.
普通外科/结直肠外科医生在文献中对系膜缺损的闭合仍存在差异。本研究旨在评估开腹右半结肠切除术后不闭合系膜缺损的长期后果。
回顾性收集了 7 年的连续数据库，共纳入了 212 例在高雄长庚纪念医院接受传统开腹右半结肠切除术且未闭合系膜缺损的连续患者；所有患者均由同一位外科医生进行手术。其中 17 例患者被排除（术后 30 天内死亡或接受末端回肠造口术）。195 例患者的平均年龄为 61.6 ± 12.6 岁，随访时间为 4.1 ± 2.8 年（四分位距 0.09~10.4 年）。
44 例（22.5%）患者发生肠梗阻。9 例（20.4%）需要手术干预。肠梗阻的原因包括粘连（n=1）、腹疝（n=1）和癌症复发（n=7）。35 例患者经保守治疗成功。肠梗阻组（n=44）与无肠梗阻组（n=151）在以下参数方面相似：年龄、性别、既往腹部手术史、结肠切除术的适应证和手术相关并发症。肿瘤转移会增加肠梗阻的发生率。没有患者因开腹右半结肠切除术后未闭合系膜缺损而发生肠梗阻。
本研究表明，开腹右半结肠切除术后常规闭合系膜缺损可能无益。需要进行更多具有扩展长期随访的研究，以确认不闭合系膜缺损的益处。
