Carpinteyro-Espín Paulina, Santes Oscar, Moctezuma-Velazquez Paulina, Navarro-Iñiguez Julio A, Navarro-Navarro Adolfo, Salgado-Nesme Noel
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
ANZ J Surg. 2023 Apr;93(4):956-962. doi: 10.1111/ans.18084. Epub 2022 Oct 5.
Restoration of bowel continuity after left extended colectomy may be challenging because the remaining colon may not reach the rectal stump without tension to perform a safe anastomosis. Performing a total colectomy with ileorectal anastomosis (IRA) is an option, but the quality of life can be significantly impaired due to loose stools and an increase in bowel frequency. In contrast, the preservation of the right colon and ileocaecal valve in the Deloyers procedure (DP) might ensure a better stool consistency and bowel transit, and therefore a superior quality of life.
A transverse study comparing patients that underwent DP versus patients with an IRA was performed. Postoperative morbidity, mortality, functional outcomes, and quality of life were analysed between groups. Quality of life after the surgical procedure was assessed with the SF-36 V2® health survey.
A total of 16 patients with DP and 32 with IRA were included. The groups had similar demographic characteristics concerning age, sex, body mass index, ASA classification, diagnosis and Charlson comorbidity index. The median follow-up was 55 months for DP and 99 months for IRA. Postoperative complications were similar in both groups. Patients in the DP group had fewer bowel movements (P = 0.01), tenesmus (P = 0.04) and use of loperamide (P = 0.03). DP patients achieved better scores in physical pain (P = 0.02) and general health (P < 0.01) than IRA patients.
DP for intestinal continuity restoration after extended left colon resection is a safe and feasible alternative, possibly achieving better functional outcomes and quality-of-life compared to IRA.
左半结肠扩大切除术后恢复肠道连续性可能具有挑战性，因为剩余的结肠可能无法无张力地到达直肠残端以进行安全的吻合。行全结肠切除回直肠吻合术（IRA）是一种选择，但由于大便变稀和排便次数增加，生活质量可能会受到显著影响。相比之下，在德洛耶手术（DP）中保留右半结肠和回盲瓣可能会确保更好的大便稠度和肠道传输，从而提高生活质量。
进行了一项横向研究，比较接受DP手术的患者与接受IRA手术的患者。分析了两组之间的术后发病率、死亡率、功能结局和生活质量。使用SF-36 V2®健康调查问卷评估手术治疗后的生活质量。
共纳入16例接受DP手术的患者和32例接受IRA手术的患者。两组在年龄、性别、体重指数、美国麻醉医师协会（ASA）分级、诊断和查尔森合并症指数方面具有相似的人口统计学特征。DP组的中位随访时间为55个月，IRA组为99个月。两组术后并发症相似。DP组患者的排便次数更少（P = 0.01）、里急后重感更少（P = 0.04）且洛哌丁胺的使用量更少（P = 0.03）。DP组患者在身体疼痛（P = 0.02）和总体健康（P < 0.01）方面的得分高于IRA组患者。
对于扩大左半结肠切除术后恢复肠道连续性，DP是一种安全可行的替代方法，与IRA相比可能实现更好的功能结局和生活质量。
