Department of Digestive Surgery.
Simplification of Surgical Patient Care Research Unit, University of Picardie Jules Verne, Amiens, France.
Surg Laparosc Endosc Percutan Tech. 2022 Dec 1;32(6):677-682. doi: 10.1097/SLE.0000000000001109.
Left colectomy is associated with a 7% risk of anastomotic leak. In 2011, a prediction score for AL [the colon leakage score (CLS)] was developed. The aim was to evaluate the impact of a defunctioning stoma on AL and its consequences after left colectomy in high-risk patients.
From January 2012 to June 2019, high-risk patients who underwent a left colectomy with anastomosis were included in this retrospective, single-center study. Two groups of patients were defined: patients undergoing a left colectomy with an anastomosis without a defunctioning stoma (no-stoma group) and those with a defunctioning stoma (stoma group). The primary endpoint was the rate of anastomotic leakage.
Ninety-two patients were included in this study. The anastomotic leakage rate was 16.4% in the no-stoma group and 21.6% in the stoma group ( P =0.5). A conservative approach was applied to 11.2% in the no-stoma group and 50% in the stoma group ( P =0.1). The severe morbidity rate was 14.5% in the no-stoma group and 21.6% in the stoma group ( P =0.4). The rate of unplanned admissions was 7% in the no-stoma group and 27% in the stoma group ( P =0.01).
A defunctioning stoma does not appear to reduce the rate of AL in high-risk patients, but its impact on the management of AL remains unclear.
左半结肠切除术有 7%的吻合口漏风险。2011 年，开发了一种用于预测 AL 的评分系统[结肠漏评分（CLS）]。本研究旨在评估预防性造口术对高危患者左半结肠切除术后吻合口漏（AL）及其后果的影响。
本回顾性单中心研究纳入了 2012 年 1 月至 2019 年 6 月期间接受左半结肠切除术和吻合术的高危患者。将患者分为两组：未行预防性造口术的左半结肠切除术和吻合术患者（无造口组）和行预防性造口术的患者（造口组）。主要终点是吻合口漏的发生率。
本研究共纳入 92 例患者。无造口组吻合口漏发生率为 16.4%，造口组为 21.6%（P=0.5）。无造口组中 11.2%的患者采用了保守治疗，而造口组中这一比例为 50%（P=0.1）。无造口组严重并发症发生率为 14.5%，造口组为 21.6%（P=0.4）。无造口组非计划再入院率为 7%，造口组为 27%（P=0.01）。
预防性造口术似乎不能降低高危患者的 AL 发生率，但它对 AL 处理的影响仍不清楚。
