Emile Sameh Hany, Freund Michael R, Horesh Nir, Garoufalia Zoe, Gefen Rachel, Silva-Alvarenga Emanuela, Wexner Steven D
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Surg Endosc. 2023 Feb;37(2):941-949. doi: 10.1007/s00464-022-09557-4. Epub 2022 Sep 6.
Repeat ileocolic resection of Crohn's disease (CD) is a challenging procedure that can be followed by a high rate of complications. The present study aimed to identify the factors associated with complications and conversion to open surgery in patients undergoing repeat ileocolic resection for CD.
This was a retrospective review of an IRB-approved prospective database of CD patients who underwent elective repeat ileocolic resection between 2011 and 2021. Univariate and multivariate analyses were performed to determine the predictive factors of postoperative complications and conversion to open surgery.
The present study included 65 patients (47.7% male) with a mean age of 52.5 years. 43.1% of patients developed short-term complications, most of which were of Clavien-Dindo class I-II. Longer operative time was found to be an independent predictor of complications (OR 1.016, p = 0.014). The preoperative use of biological therapy was an independent protective factor from complications (OR 0.243, p = 0.016). The only significant risk factor of a longer operation time was higher BMI (OR 3.11, p = 0.044). Overall, 28.1% of laparoscopic procedures were converted to laparotomy. According to bivariate analysis, previous ileocolic open resection (OR 190, p < 0.0001), longer operation time (OR 1.01; p = 0.036), and takedown of incidental fistula of incidental fistula (OR 3.78, p = 0.04) were associated with higher odds of conversion to open surgery.
Longer operation time was significantly associated with and predictive of complications after repeat ileocolic resection of CD. Preoperative biological therapy was predictive of a lower rate of complications. Previous ileocolic resection by laparotomy, longer operation time, and takedown of fistula were associated with a higher likelihood of conversion to open surgery.
克罗恩病（CD）的重复回结肠切除术是一项具有挑战性的手术，术后并发症发生率较高。本研究旨在确定接受CD重复回结肠切除术患者发生并发症及转为开放手术的相关因素。
这是一项对2011年至2021年间接受择期重复回结肠切除术的CD患者的IRB批准的前瞻性数据库进行的回顾性研究。进行单因素和多因素分析以确定术后并发症及转为开放手术的预测因素。
本研究纳入65例患者（男性占47.7%），平均年龄52.5岁。43.1%的患者出现短期并发症，大多数为Clavien-Dindo I-II级。发现手术时间较长是并发症的独立预测因素（OR 1.016，p = 0.014）。术前使用生物治疗是并发症的独立保护因素（OR 0.243，p = 0.016）。手术时间较长的唯一显著风险因素是较高的体重指数（OR 3.11，p = 0.044）。总体而言，28.1%的腹腔镜手术转为开腹手术。根据双因素分析，既往回结肠开放切除术（OR 190，p < 0.0001）、手术时间较长（OR 1.01；p = 0.036）和处理意外瘘管（OR 3.78，p = 0.04）与转为开放手术的较高几率相关。
手术时间较长与CD重复回结肠切除术后并发症显著相关且可预测并发症。术前生物治疗可预测较低的并发症发生率。既往开腹回结肠切除术、手术时间较长和瘘管处理与转为开放手术的较高可能性相关。
