Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Department of Abdominal Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Colorectal Dis. 2023 Jun;25(6):1079-1089. doi: 10.1111/codi.16498. Epub 2023 Feb 21.
The key to successful construction of an ileal pouch-anal anastomosis (IPAA) following proctocolectomy in patients with ulcerative colitis or familial adenomatous polyposis is the ability of the pouch reservoir to reach the anus well vascularized and without tension. The aim of this systematic review was to provide an overview of previously described different surgical lengthening techniques to achieve adequate length for a tension-free IPAA.
Pubmed, Embase and Cochrane Library databases were systematically searched. Two reviewers conducted a systematic search with combinations of keywords for the surgical procedure and surgical lengthening techniques. All publications that reported one or more surgical lengthening techniques during IPAA surgery in adult patients were selected, consisting of reviews, cohort studies, case reports, human cadaver studies and expert opinions. The primary outcomes measured were the different surgical lengthening techniques and the step-by-step approach they involve that can be used during surgery to achieve adequate length for an IPAA.
Of 1577 records reviewed, 19 articles were included in this systematic review describing at least 1181 patients (i.e. one review, four retrospective studies, five human cadaver studies, two case reports and seven expert opinions). A total of six different surgical lengthening techniques with various subtechniques were found and described, consisting of pouch folding, construction of different types of pouches, stepladder incisions, skeletonization of vessels, division and ligation of mesenteric vessels and using an interposition vein graft. No prospective or randomized controlled trials were performed regarding this topic. Quality assessment showed a medium quality of the included studies.
Different surgical lengthening techniques are described in a step-by-step approach to create adequate mesenteric length during IPAA surgery, in patients in whom the ileal pouch cannot reach the dentate line.
在溃疡性结肠炎或家族性腺瘤性息肉病患者行直肠结肠切除术后，成功构建回肠贮袋肛管吻合术（IPAA）的关键在于贮袋能够良好地到达肛门并避免张力。本系统评价的目的是综述先前描述的不同的手术延长技术，以获得无张力 IPAA 所需的足够长度。
系统检索了 Pubmed、Embase 和 Cochrane Library 数据库。两位审阅者结合手术程序和手术延长技术的关键词进行了系统搜索。选择了所有报告在成人患者的 IPAA 手术中使用一种或多种手术延长技术的出版物，包括综述、队列研究、病例报告、人体尸体研究和专家意见。主要结局指标是不同的手术延长技术以及在手术中可以用于实现 IPAA 足够长度的逐步方法。
在审查的 1577 份记录中，有 19 篇文章纳入了本系统评价，共描述了 1181 例患者（即一篇综述、四项回顾性研究、五项人体尸体研究、两项病例报告和七项专家意见）。共发现并描述了六种不同的手术延长技术及其各种亚技术，包括贮袋折叠、不同类型贮袋的构建、阶梯状切口、血管骨骼化、肠系膜血管的分离和结扎以及使用静脉间置移植物。针对这一主题，没有进行前瞻性或随机对照试验。质量评估显示纳入研究的质量中等。
在 IPAA 手术中，针对贮袋无法到达齿状线的患者，描述了一种逐步的手术延长技术，以创建足够的肠系膜长度。
