General Surgery Department, Mansoura University Hospitals, Mansoura University, Egypt.
Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. Electronic address: https://twitter.com/SualehMKhan.
Surgery. 2021 Dec;170(6):1629-1636. doi: 10.1016/j.surg.2021.06.009. Epub 2021 Jul 2.
Ileal-pouch anal anastomosis is used for treatment of different conditions, including mucosal ulcerative colitis and familial adenomatous polyposis. The present systematic review aimed to assess the literature for studies that compared the outcome of ileal-pouch anal anastomosis in patients with obesity versus patients with ideal weight.
A systematic literature search of electronic databases including PubMed, Scopus, Web of Science, and Cochrane library was performed and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main outcome measures were pouch failure, pouch complications, overall complications, operation time, blood loss, and hospital stay.
This systematic review included 6 retrospective studies (3,460 patients). Out of the total number of patients, 19.8% had obesity or overweight. Patients with obesity were significantly less likely to have laparoscopic ileal-pouch anal anastomosis compared with patients with ideal body mass index (odds ratio = 0.436; P = .017). The weighted mean operation time and blood loss were significantly longer in the obesity group than the ideal weight group (weighted mean difference = 22.84; P = .006) and (weighted mean difference = 85.8; P < .001). The obesity group was associated with significantly higher odds of total complications (odds ratio = 2.27; P < .001), leak (odds ratio = 1.81; P = .036), and incisional hernia (odds ratio = 4.56; P < .001). The 2 groups had comparable rates of pouch failure, pouchitis, stricture, pelvic sepsis, wound infection, bowel obstruction, ileus, and venous thromboembolism. Male sex, longer operation time, and including inflammatory bowel disease patients only were significantly associated with higher complications in the obesity group.
Patients with obesity who undergo ileal-pouch anal anastomosis are more likely to have laparotomy rather than a laparoscopic procedure, have longer operation time, greater blood loss, higher overall complications, leak and incisional hernia, and longer hospital stay.
回肠贮袋肛管吻合术用于治疗不同疾病，包括黏膜溃疡性结肠炎和家族性腺瘤性息肉病。本系统评价旨在评估比较肥胖患者与理想体重患者回肠贮袋肛管吻合术结局的文献。
对电子数据库（包括 PubMed、Scopus、Web of Science 和 Cochrane 图书馆）进行系统文献检索，并按照系统评价和荟萃分析的首选报告项目进行报告。主要结局指标为贮袋失败、贮袋并发症、总并发症、手术时间、出血量和住院时间。
本系统评价纳入 6 项回顾性研究（3460 例患者）。在总患者人数中，19.8%的患者肥胖或超重。与理想体重指数的患者相比，肥胖患者行腹腔镜回肠贮袋肛管吻合术的可能性显著降低（比值比=0.436；P=0.017）。肥胖组的加权平均手术时间和出血量明显长于理想体重组（加权均数差=22.84；P=0.006）和（加权均数差=85.8；P<0.001）。肥胖组总并发症的发生几率显著更高（比值比=2.27；P<0.001）、漏（比值比=1.81；P=0.036）和切口疝（比值比=4.56；P<0.001）。两组的贮袋失败、贮袋炎、狭窄、盆腔脓毒症、伤口感染、肠梗阻、肠麻痹和静脉血栓栓塞的发生率无差异。男性、手术时间较长以及仅纳入炎症性肠病患者与肥胖组较高的并发症发生率显著相关。
肥胖患者行回肠贮袋肛管吻合术更可能选择开腹手术而非腹腔镜手术，手术时间较长、出血量较大、总并发症、漏和切口疝的发生率较高，住院时间较长。
