Department of Surgery, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Tech Coloproctol. 2023 Apr;27(4):271-279. doi: 10.1007/s10151-022-02688-9. Epub 2022 Aug 30.
Although there are various surgical causes of and therapeutic approaches to the chronically failing ileoanal pouch (PF), cases are often detailed without distinguishing the exact cause and corresponding treatment. The aim of our study was to classify causes of PF and corresponding surgical treatment options, and to establish efficacy of surgical approach per cause.
This retrospective study included all consecutive adult patients with chronic PF surgically treated at our tertiary hospital between July 2014 and March 2021. Patients were classified according to a proposed sub-classification for surgical related chronic PF. Results were reported accordingly.
A total of 59 procedures were completed in 50 patients (64% male, median age 45 years [IQR 34.5-54.3]) for chronic PF. Most patients had refractory ulcerative colitis as indication for their restorative proctocolectomy (68%). All patients could be categorized according to the sub-classification. Reasons for chronic PF were septic complications (n = 25), pouch body complications (n = 12), outlet problems (n = 11), cuff problems (n = 8), retained rectum (n = 2), and inlet problems (n = 1). For these indications, 17 pouches were excised, 10 pouch reconstructions were performed, and 32 pouch revision procedures were performed. The various procedures had different complication rates. Technical success rates of redo surgery for the different causes varied from 0 to 100%, with a 75% success rate for septic causes.
Our sub-classification for chronic PF and corresponding treatments is suitable for all included patients. Outcomes varied between causes and subsequent management. Chronic PF was predominantly caused by septic complications with redo surgery achieving a 75% technical success rate.
尽管慢性失败的回肠贮袋（PF）有多种手术原因和治疗方法，但病例通常详细描述而不区分确切的原因和相应的治疗方法。我们的研究目的是对 PF 的病因进行分类，并确定相应的手术治疗选择，并根据病因确定手术方法的疗效。
本回顾性研究纳入了 2014 年 7 月至 2021 年 3 月期间在我们的三级医院接受慢性 PF 手术治疗的所有连续成年患者。患者根据提出的用于手术相关慢性 PF 的亚分类进行分类。结果据此报告。
共有 50 名患者（64%为男性，中位年龄 45 岁[IQR 34.5-54.3]）接受了 59 次手术治疗慢性 PF。大多数患者溃疡性结肠炎的指征是接受修复性直肠结肠切除术（68%）。所有患者均可根据亚分类进行分类。慢性 PF 的原因是感染性并发症（n=25）、贮袋体并发症（n=12）、出口问题（n=11）、袖口问题（n=8）、残留直肠（n=2）和入口问题（n=1）。对于这些指征，切除了 17 个贮袋，进行了 10 个贮袋重建，进行了 32 个贮袋修复手术。各种手术的并发症发生率不同。不同病因的再手术技术成功率从 0 到 100%不等，感染性病因的成功率为 75%。
我们对慢性 PF 的亚分类和相应的治疗方法适用于所有纳入的患者。结果因病因和后续管理而有所不同。慢性 PF 主要由感染性并发症引起，再手术的技术成功率为 75%。
