Portsmouth Hospitals NHS Trust, Portsmouth, UK.
University of Portsmouth, Portsmouth, UK.
Updates Surg. 2021 Feb;73(1):149-156. doi: 10.1007/s13304-020-00918-z. Epub 2021 Jan 6.
A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD.
局限性回肠末端切除术是治疗回肠末端 CD 的最常用方法，已经描述了不同的吻合技术。本文审查了在一项全国性研究中使用的不同吻合技术，并评估了它们对原发性 CD 行回肠末端切除术后的术后结果的影响。这是一项由意大利结直肠外科学会（SICCR）发起的回顾性、多中心、观察性研究，纳入了 2018 年 6 月至 2019 年 5 月期间所有因原发性 CD 行择期回肠末端切除术的成年人。手术 30 天内的术后发病率是主要终点。术后住院时间（LOS）和吻合口漏率是次要结果。共纳入 427 例患者。380 例（89%）选择侧侧吻合，286 例（67%）选择吻合器吻合，141 例（33%）选择手工吻合。术后发病率为 20.3%，吻合口漏为 3.7%。吻合口漏与吻合方式无关，而与 ASA 分级≥3、肛周疾病存在和回结肠定位疾病有关。多变量分析后确定了 LOS 的 4 个预测因素。腹腔镜入路是唯一与 LOS 降低相关的因素（p=0.017），而年龄、ASA 分级≥3 或术前 TPN 给药与 LOS 增加相关。在原发性 CD 切除术后，侧侧吻合是最常用的回肠末端重建吻合方式。吻合技术和吻合方式与术后发病率无差异。吻合口漏与 ASA 分级≥3、疾病穿透表型和 CD 回结肠分布有关。
