Tapaskar Natalie, Genere Juan Reyes, Prachand Vivek N, Semrad Carol E
Department of Medicine, The University of Chicago, Chicago, USA.
University of Chicago Medical Center, 5841 S Maryland Avenue, MC 4076, Chicago, IL, 60637, USA.
Surg Endosc. 2022 May;36(5):3227-3233. doi: 10.1007/s00464-021-08632-6. Epub 2021 Jul 21.
Double-balloon enteroscopy (DBE) is used for the diagnosis and therapy of small bowel disease. Endoscopic sampling and marking small bowel lesions destined for surgery permit intracorporeal resection and reconstruction (IRR), thereby facilitating a complete minimally invasive technique. There are limited data that compare outcomes of IRR to conventional extracorporeal resection and reconstruction (ERR). The purpose of this study was to evaluate the surgical outcomes of patients undergoing pre-operative DBE for lesion marking followed by laparoscopic IRR compared to those undergoing ERR.
A retrospective chart review was performed on patients who underwent DBE followed by small bowel resection from 2006 to 2017 at a single tertiary care medical center. IRR was defined as laparoscopic inspection to identify the lesion (previously marked by DBE or by laparoscopic-assisted DBE) followed by intra-abdominal bowel resection and anastomosis with specimen extraction via minimal extension of a laparoscopic port site. ERR was defined as extracorporeal resection and/or reconstruction performed via a conventional or mini-laparotomy abdominal incision.
A total of 82 patients met inclusion criteria and were reviewed. Thirty-two patients (39%) had ERR and 50 patients (61%) had IRR. The most common indications for DBE were small bowel bleeding (76%) and small bowel mass or thickening on prior imaging studies (16%). Successful DBE was higher in the IRR group when compared to the ERR group, but not significantly different (90% vs 75%, p-value 0.07). Patients who underwent IRR had faster bowel function recovery (2 vs 4 days, p < 0.01), shorter time to discharge (3 vs 7 days, p < 0.01), and fewer post-operative complications (10 vs 18; p < 0.01), when compared to the ERR group.
DBE successfully facilitated laparoscopic small bowel IRR and this approach was associated with faster return of bowel function, shorter recovery time, and decreased morbidity when compared to ERR.
双气囊小肠镜检查（DBE）用于小肠疾病的诊断和治疗。对预定手术的小肠病变进行内镜取样和标记可实现体内切除和重建（IRR），从而促进完整的微创技术。比较IRR与传统体外切除和重建（ERR）结果的数据有限。本研究的目的是评估术前接受DBE进行病变标记然后进行腹腔镜IRR的患者与接受ERR的患者的手术结果。
对2006年至2017年在一家三级医疗中心接受DBE并随后进行小肠切除的患者进行回顾性病历审查。IRR定义为通过腹腔镜检查识别病变（先前由DBE或腹腔镜辅助DBE标记），然后进行腹腔内肠切除和吻合，并通过最小限度扩大腹腔镜端口部位取出标本。ERR定义为通过传统或迷你剖腹手术腹部切口进行体外切除和/或重建。
共有82例患者符合纳入标准并接受审查。32例患者（39%）接受ERR，50例患者（61%）接受IRR。DBE最常见的适应证是小肠出血（76%）和先前影像学检查显示的小肠肿块或增厚（16%）。与ERR组相比，IRR组DBE的成功率更高，但差异无统计学意义（90%对75%，p值0.07）。与ERR组相比，接受IRR的患者肠功能恢复更快（2天对4天，p<0.01），出院时间更短（3天对7天，p<0.01），术后并发症更少（10例对18例；p<0.01）。
DBE成功促进了腹腔镜小肠IRR，与ERR相比，这种方法与更快恢复肠功能、更短的恢复时间和更低的发病率相关。
