Belvedere Angela, Dajti Gerti, Larotonda Cristina, Angelicchio Laura, Rizzello Fernando, Gionchetti Paolo, Poggioli Gilberto, Rottoli Matteo
Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40128 Bologna, Italy.
J Clin Med. 2023 Feb 9;12(4):1392. doi: 10.3390/jcm12041392.
Anastomotic leak (AL) remains one of the most relevant complications after intestinal resection for Crohn's disease (CD). While surgery has always been considered the standard treatment for perianastomotic collection, percutaneous drainage (PD) has been proposed as a potential alternative.
Retrospective study in consecutive patients treated with either PD or surgery for AL after intestinal resection for CD between 2004 and 2022. AL was defined as a perianastomotic fluid collection confirmed by radiological findings. Patients with generalized peritonitis or clinical instability were excluded.
To compare the success rate of PD vs. surgery. Secondary aims: To compare the outcomes at 90 days after the procedures; to identify the variables associated with the indication for PD.
A total of 47 patients were included, of which 25 (53%) underwent PD and 22 (47%) surgery. The success rate was 84% in the PD and 95% in the surgery group ( = 0.20). There were no significant differences between the PD and surgery group in postoperative medical and surgical complications, discharge, readmission or reoperation rates at 90 days. PD was more likely to be performed in patients with later diagnosis of AL (OR 1.25, 95% CI 1.03-1.53, = 0.027), undergoing ileo-colic anastomosis alone (OR 3.72, 95% CI 2.29-12.45, = 0.034) and treated after 2016 (OR 6.36, 95% CI 1.04-39.03, = 0.046).
The present study suggests that PD is a safe and effective procedure to treat anastomotic leak and perianastomotic collection in CD patients. PD should be indicated in all eligible patients as an effective alternative to surgery.
吻合口漏（AL）仍然是克罗恩病（CD）肠切除术后最严重的并发症之一。虽然手术一直被视为治疗吻合口周围积液的标准方法，但经皮引流（PD）已被提议作为一种潜在的替代方法。
对2004年至2022年间因CD肠切除术后发生AL而接受PD或手术治疗的连续患者进行回顾性研究。AL被定义为经影像学检查证实的吻合口周围积液。排除患有弥漫性腹膜炎或临床不稳定的患者。
比较PD与手术的成功率。次要目的：比较术后90天的结局；确定与PD指征相关的变量。
共纳入47例患者，其中25例（53%）接受了PD治疗，22例（47%）接受了手术治疗。PD组的成功率为84%，手术组为95%（P = 0.20）。PD组和手术组在术后医疗和手术并发症、出院、90天再入院或再次手术率方面无显著差异。PD更有可能在AL诊断较晚的患者中进行（OR 1.25，95%CI 1.03 - 1.53，P = 0.027），仅接受回结肠吻合术的患者中进行（OR 3.72，95%CI 2.29 - 12.45，P = 0.034），以及2016年后接受治疗的患者中进行（OR 6.36，95%CI 1.04 - 39.03，P = 0.046）。
本研究表明，PD是治疗CD患者吻合口漏和吻合口周围积液的一种安全有效的方法。PD应作为手术的有效替代方法应用于所有符合条件的患者。
