Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA.
Am Surg. 2020 Oct;86(10):1296-1301. doi: 10.1177/0003134820964227.
Contrast enema is the gold standard technique for evaluating a pelvic anastomosis (PA) prior to ileostomy closure. With the increasing use of flexible endoscopic modalities, the need for contrast studies may be unnecessary. The objective of this study is to compare flexible endoscopy and contrast studies for anastomotic inspection prior to defunctioning stoma reversal. Patients with a protected PA undergoing ileostomy closure between July 2014 and June 2019 at our institution were retrospectively identified. Demographics and clinical outcomes in patients undergoing preoperative evaluation with endoscopic and/or contrast studies were analyzed. We identified 207 patients undergoing ileostomy closure. According to surgeon's preference, 91 patients underwent only flexible endoscopy (FE) and 100 patients underwent both endoscopic and contrast evaluation (FE + CE) prior to reversal. There was no significant difference in pelvic anastomotic leak (2.2% vs. 1%), anastomotic stricture (1.1% vs. 6%), pelvic abscess (2.2% vs. 3.0%), or postoperative anastomotic complications (4.4% vs. 9%) between groups FE and FE + CE ( > .05). Flexible endoscopy alone appears to be an acceptable technique for anastomotic evaluation prior to ileostomy closure. Further studies are needed to determine the effectiveness of different diagnostic modalities for pelvic anastomotic inspection.
对比灌肠是评估回肠造口关闭前盆腔吻合术（PA）的金标准技术。随着灵活的内镜方式的广泛应用，可能不再需要进行对比研究。本研究的目的是比较灵活的内镜检查和对比研究，以评估预防性造口反转前吻合口的情况。我们回顾性地确定了 2014 年 7 月至 2019 年 6 月期间在我们机构接受保护性 PA 回肠造口关闭的患者。分析了接受术前内镜和/或对比研究评估的患者的人口统计学和临床结果。我们确定了 207 例接受回肠造口关闭的患者。根据外科医生的偏好，91 例患者仅接受了灵活的内镜检查（FE），100 例患者在反转前同时进行了内镜和对比评估（FE + CE）。FE 组和 FE + CE 组之间在盆腔吻合口漏（2.2% vs. 1%）、吻合口狭窄（1.1% vs. 6%）、盆腔脓肿（2.2% vs. 3.0%）或术后吻合口并发症（4.4% vs. 9%）方面没有显著差异（>.05）。单独使用灵活的内镜检查似乎是一种可接受的技术，用于评估回肠造口关闭前的吻合口。需要进一步的研究来确定不同诊断方式在评估盆腔吻合口方面的有效性。
