Division of Colorectal Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA.
Int J Colorectal Dis. 2021 Jul;36(7):1543-1550. doi: 10.1007/s00384-021-03957-z. Epub 2021 May 26.
Recent data has suggested that primary anastomosis (PA), with or without a diverting loop ileostomy (DLI), is a safe option for the treatment of acute complicated diverticulitis. This study aimed to evaluate risk factors associated with anastomotic leak in patients who underwent a sigmoid colectomy with PA and to determine whether a DLI was protective against a clinically significant anastomotic leak.
Patients with acute complicated diverticulitis who underwent a laparoscopic or open sigmoid colectomy with PA, with or without a DLI, were identified in the NSQIP PUF(2016-2017). The rates of anastomotic leak, receipt of DLI, and type of leak management were compared. Multivariate logistic regression was performed.
There were 497 patients identified. Seventy-nine(15.9%) patients had a DLI, while 418 (84.1%) did not. Twenty-six anastomotic leaks were identified (5.2%). On multivariate analysis, current smoking (OR 4.02; 95% CI 1.44-11.26) and chronic steroid use (OR 3.84; 95% CI 1.16-12.69) were significantly associated with an increased risk of leak. Of the 26 patients with anastomotic leaks, 5 (19.2%) had a DLI. There was no significant difference in the rate of leak between those with a DLI(5; 6.3%) and those without(21; 5.3%; p = 0.59). Patients who had a DLI were significantly less likely to experience an anastomotic leak requiring re-operation (p < 0.01).
Regardless of the presence of a DLI, chronic steroid use and smoking are associated with an increased risk of anastomotic leak in patients with acute complicated diverticulitis undergoing colectomy with PA. The presence of a diverting loop ileostomy is protective against re-operation.
最近的数据表明，对于急性复杂憩室炎的治疗，单纯吻合术（PA），无论是否联合预防性回肠造口术（DLI），都是一种安全的选择。本研究旨在评估接受 PA 吻合术的患者中与吻合口漏相关的危险因素，并确定 DLI 是否可以预防临床显著的吻合口漏。
在 NSQIP PUF（2016-2017）中，识别出接受腹腔镜或开放性乙状结肠切除术伴或不伴 DLI 的急性复杂憩室炎患者。比较吻合口漏、DLI 接受情况和漏口管理类型。进行多变量逻辑回归分析。
共纳入 497 例患者。79 例（15.9%）患者行 DLI，418 例（84.1%）未行 DLI。26 例吻合口漏（5.2%）。多变量分析显示，当前吸烟（OR 4.02；95%CI 1.44-11.26）和慢性类固醇使用（OR 3.84；95%CI 1.16-12.69）与漏口风险增加显著相关。26 例吻合口漏患者中，5 例（19.2%）行 DLI。有 DLI 的患者（5 例；6.3%）与无 DLI 的患者（21 例；5.3%；p=0.59）的漏口发生率无显著差异。有 DLI 的患者发生需要再次手术的吻合口漏的可能性明显降低（p<0.01）。
无论是否存在 DLI，慢性类固醇使用和吸烟与接受 PA 吻合术的急性复杂憩室炎患者吻合口漏的风险增加相关。预防性回肠造口术的存在可以预防再次手术。
