Department of Surgery, University Hospital of Zaragoza, San Juan Bosco 15, 50009, Saragossa, Spain.
Aragon Health Research Institute, San Juan Bosco 13, 50009, Saragossa, Spain.
Langenbecks Arch Surg. 2023 Jan 6;408(1):11. doi: 10.1007/s00423-022-02745-9.
After a full-thickness total wall excision of a rectal tumor, suturing the defect is generally recommended. Recently, due to various contradictory studies, there is a trend to leave the defects open. Therefore, this study aimed to determine whether leaving the defect open is an adequate management strategy compared with suturing it closed based on postoperative outcomes and recurrences.
A retrospective review of our prospectively maintained database was conducted. Adult patients who underwent transanal surgery for rectal neoplasm in our institution from 1997 to 2019 were analyzed. Patients were divided into two groups: sutured (group A) or unsutured (group B) rectal defect. The primary outcomes were morbidity (early and late) and recurrence.
In total, 404 (239 men) patients were analyzed, 143 (35.4%) from group A and 261 (64.6%) from group B. No differences were observed in tumor size, distance from the anal verge or operation time. The overall incidence of complications was significantly higher in patients from group B, which nearly double the rate of group A. With a mean follow-up of 58 (range, 12-96) months, seven patients presented with a rectal stricture, all of them from group B.
We acknowledge the occasional impossibility of closing the defect in patients who undergo local excision; however, when it is possible, the present data suggest that there may be advantages to suturing the defect closed.
在全层全壁切除直肠肿瘤后，通常建议缝合缺损。最近，由于各种相互矛盾的研究，存在使缺损开放的趋势。因此，本研究旨在根据术后结果和复发情况，确定与缝合关闭相比，使缺损开放是否是一种充分的管理策略。
对我们前瞻性维护的数据库进行回顾性分析。分析了 1997 年至 2019 年在我们机构接受经肛门手术治疗直肠肿瘤的成年患者。患者分为两组：缝合（A 组）或未缝合（B 组）直肠缺损。主要结局是发病率（早期和晚期）和复发。
共分析了 404 名（239 名男性）患者，其中 143 名（35.4%）来自 A 组，261 名（64.6%）来自 B 组。肿瘤大小、距肛缘的距离或手术时间均无差异。B 组患者的并发症总发生率明显更高，几乎是 A 组的两倍。平均随访 58 个月（范围 12-96 个月），7 名患者出现直肠狭窄，均来自 B 组。
我们承认在接受局部切除的患者中偶尔无法关闭缺损；然而，当有可能时，目前的数据表明，缝合关闭缺损可能有优势。
