Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China.
Updates Surg. 2021 Apr;73(2):561-567. doi: 10.1007/s13304-020-00890-8. Epub 2020 Sep 26.
Reversal of loop ileostomy after colorectal surgery in obese patients can be challenging and total laparoscopic (TLAP) approach may be beneficial. This study aims to compare short-term outcomes of TLAP and open approaches in obese patients undergoing loop ileostomy reversal after laparoscopic-assisted colorectal surgery. A retrospective review was performed for consecutive patients who underwent laparoscopic-assisted colorectal surgery previously and underwent loop ileostomy reversal between January 2017 and April 2020. TLAP and open cases performed in obese patients were identified and compared for the following outcomes: baseline characteristics, operative outcomes, postoperative recovery, and postoperative complications. TLAP or open-loop ileostomy reversal was performed on 30 and 34 patients, respectively. TLAP approach was associated with a similar operation time and blood loss compared with an open approach (P > 0.05). The median length of incision for stoma removal was significantly shorter in the TLAP group than in the open group (6.5 cm vs. 8.5 cm; P < 0.05), and a lower incidence of incisional infection was also noted in the TLAP group (6.7% vs. 26.5%; P < 0.05). The groups were comparable as regards the time to ground activities and length of hospitalization (P > 0.05), but the time to first flatus was decreased (2.0 vs. 3.0 days; P < 0.05). This retrospective study demonstrated that TLAP loop ileostomy reversal may have a satisfactory short-term outcome for obese patients after laparoscopic-assisted colorectal surgery, with a shorter incisional length and a lower incidence of incisional infection as well as an earlier time to first flatus.
肥胖患者行结直肠手术后行回肠袢式造口还纳术具有挑战性，全腹腔镜（TLAP）方法可能有益。本研究旨在比较肥胖患者行腹腔镜辅助结直肠手术后行回肠袢式造口还纳术时 TLAP 和开放方法的短期结果。对 2017 年 1 月至 2020 年 4 月期间行腹腔镜辅助结直肠手术并接受回肠袢式造口还纳术的连续患者进行了回顾性研究。确定并比较了肥胖患者中行 TLAP 和开放手术的病例，比较了以下结果：基线特征、手术结果、术后恢复和术后并发症。TLAP 或开放式回肠造口还纳术分别进行 30 例和 34 例。TLAP 方法与开放方法的手术时间和出血量相似（P>0.05）。TLAP 组的造口切除切口长度中位数明显短于开放组（6.5cm 比 8.5cm；P<0.05），TLAP 组切口感染发生率也较低（6.7%比 26.5%；P<0.05）。两组在开始下地活动时间和住院时间方面无差异（P>0.05），但 TLAP 组首次排气时间较早（2.0 天比 3.0 天；P<0.05）。这项回顾性研究表明，TLAP 回肠袢式造口还纳术对于腹腔镜辅助结直肠手术后的肥胖患者可能具有良好的短期效果，具有较短的切口长度和较低的切口感染发生率，以及较早的首次排气时间。
