Caprino P, Giambusso M, Sacchetti F, Potenza A E, Pastena D, Panunzi S, Piergentili I, Sofo L
Abdominal Surgery Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation and IRCCS, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(5):1945-1953. doi: 10.26355/eurrev_202303_31559.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical gold standard in patients with ulcerative colitis (UC). Results are generally satisfactory but there is a significant rate of patients who experience postoperative complications. The aims of our study were to identify the pre- and intraoperative risk factors and their correlation with the reported outcomes.
A retrospective study was conducted on the medical records of all consecutive patients undergoing restorative proctocolectomy with IPAA for UC in our center from 2010 to 2021. Pre- and intraoperative factors were examined and correlated with pouchitis, endoscopic pouchitis, pouch failure, anastomotic leak, postoperative complications classified according to Clavien-Dindo score and stoma outlet obstruction. A univariate and multivariate statistical analysis was performed.
Out of 75 patients undergoing 3- or 2-stage IPAA surgery, the coexistence of extraintestinal clinical manifestations and preoperative topical rectal stump therapy for active proctitis were significantly associated with the occurrence of pouchitis (OR=4.4, p=0.03 and OR=7.6, p=0.01). Endoscopic pouchitis was found to be related to preoperative topical rectal therapy (OR=10.2, p=0.007), but not to extraintestinal manifestations of disease. Anastomotic leak was found to be significantly related to pouch failure (OR=22.7, p=0.007). Surgical indication for malignancy increased the risk for early complications (Clavien-Dindo >2) (OR=16.0, p=0.04). Young age was associated with the occurrence of outlet stoma obstruction in patients with recent IPAA surgery (OR=0.97, p=0.05).
Based on observed results, an appropriate preoperative patient assessment aimed at detecting specific risk factors is crucial to identify early or prevent worse outcomes in patients undergoing IPAA surgery.
回肠储袋肛管吻合术（IPAA）行结直肠全切除重建术是溃疡性结肠炎（UC）患者的手术金标准。总体结果令人满意，但仍有相当比例的患者出现术后并发症。本研究的目的是确定术前和术中的危险因素及其与报告结果的相关性。
对2010年至2021年在本中心接受IPAA行结直肠全切除重建术治疗UC的所有连续患者的病历进行回顾性研究。检查术前和术中因素，并将其与袋炎、内镜下袋炎、储袋功能衰竭、吻合口漏、根据Clavien-Dindo评分分类的术后并发症和造口出口梗阻进行相关性分析。进行单因素和多因素统计分析。
在75例行3期或2期IPAA手术的患者中，肠外临床表现的共存以及术前对活动性直肠炎的局部直肠残端治疗与袋炎的发生显著相关（OR=4.4，p=0.03；OR=7.6，p=0.01）。发现内镜下袋炎与术前局部直肠治疗有关（OR=10.2，p=0.007），但与疾病的肠外表现无关。发现吻合口漏与储袋功能衰竭显著相关（OR=22.7，p=0.007）。恶性肿瘤的手术指征增加了早期并发症（Clavien-Dindo>2）的风险（OR=16.0，p=0.04）。年轻与近期IPAA手术患者造口出口梗阻的发生有关（OR=0.97，p=0.05）。
基于观察结果，旨在检测特定危险因素的适当术前患者评估对于识别接受IPAA手术患者的早期情况或预防更差结果至关重要。
