Colorectal Surgery, Spectrum Health/Ferguson Clinic, USA.
Michigan State University, Staff Surgeon, Colorectal Surgery, Spectrum Health/Ferguson Clinic, USA.
Am J Surg. 2020 Oct;220(4):1010-1014. doi: 10.1016/j.amjsurg.2020.02.031. Epub 2020 Feb 16.
Stomal prolapse is an uncommon complication related to ostomy creation without comparative studies to suggest an optimal approach. Our aim was to assess long-term recurrence rates following surgical repair, specifically local repair vs. laparotomy.
We conducted a retrospective review of patients who underwent surgical correction of a prolapsed stoma by dedicated colorectal surgeons. The primary outcome was recurrence. We evaluated perioperative risk factors for long-term recurrence, focusing on the surgical approach.
Over 12 years, 23 patients underwent 37 surgeries (median follow-up 24 months, range 1-126). Repeat operations for recurrence were performed in 43.5% of patients, 80% within one year. Recurrence was similar regardless of the surgical approach; 43.6% local repair vs 42.9% laparotomy (p = 0.41). Age, sex, body mass index, smoking status, ASA score, type of stoma, and urgency of repair were not associated with recurrence. Re-recurrence resulting in a third operation, occurred in 50% of patients.
Operative repair of stomal prolapse, regardless of approach, is associated with high recurrence rates. No identifiable factors were associated with recurrence.
肠造口脱垂是一种与造口术相关的罕见并发症，目前尚无比较研究来确定最佳的治疗方法。我们旨在评估手术修复后的长期复发率，特别是局部修复与剖腹手术的比较。
我们对专门的结直肠外科医生进行的脱垂肠造口修复手术的患者进行了回顾性研究。主要结局是复发。我们评估了长期复发的围手术期风险因素，重点关注手术方法。
在 12 年期间，23 名患者接受了 37 次手术（中位随访时间为 24 个月，范围为 1-126 个月）。43.5%的患者需要再次手术治疗复发，80%的患者在一年内复发。手术方法与复发率无关；局部修复的复发率为 43.6%，剖腹手术的复发率为 42.9%（p=0.41）。年龄、性别、体重指数、吸烟状况、ASA 评分、造口类型和修复的紧急程度与复发无关。由于再次复发而进行第三次手术的患者占 50%。
肠造口脱垂的手术修复，无论采用何种方法，都与高复发率相关。没有可识别的因素与复发相关。
