Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, OH.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, OH.
Surgery. 2023 Oct;174(4):753-757. doi: 10.1016/j.surg.2023.03.006. Epub 2023 Apr 19.
Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients requiring surgery for inflammatory bowel disease. A stricture located at the inlet of the afferent limb can lead to small bowel obstruction in a limited number of patients with a pelvic pouch. This paper aims to examine our experience with afferent limb stricture surgical correction when other endoscopic treatment methods have failed to control obstructive symptoms.
All consecutive eligible patients with ileal pouch-anal anastomosis and afferent limb stricture were identified from our institutional review board-approved database from 1990 to 2021. Patients surgically treated with excision and reimplantation/strictureplasty of afferent limb stricture were included in this study.
Twenty patients met our inclusion criteria. Fifteen (75%) were female, and the overall mean age was 41 ± 10.3 years at afferent limb stricture surgery. The interval from ileal pouch-anal anastomosis formation to surgery for afferent limb stricture was 13.5 ± 6.7 years. Nine (45%) underwent strictureplasty, and 11 (55%) had resection and reimplantation of the afferent limb into the pouch. Before afferent limb stricture surgery, 3 (15%) required a diverting ileostomy for their obstructive symptoms. An additional 12 (60%) had a stoma constructed during afferent limb stricture surgery, and 5 had a strictureplasty and no stoma. Postoperatively, 1 patient (5%) had a leak at the afferent limb stricture repair site. All patients had their ileostomy closed 3.2 (2.99-3.6) months after surgery. Long-term after afferent limb stricture surgery, recurrent small bowel obstruction symptoms recurred in 7 (35%) patients 3.9 (2.6-5.8) years later.
Afferent limb stricture can be treated effectively with salvage surgery. The surgical intervention appears durable and provides an acceptable outcome for their obstructive symptoms.
回肠贮袋肛管吻合术是炎症性肠病患者手术治疗的首选方法。少数接受盆腔贮袋回肠造口术的患者，吻合口输入襻的狭窄可导致小肠梗阻。本文旨在探讨我们在其他内镜治疗方法无法控制梗阻症状时，对输入襻狭窄的手术矫正经验。
从 1990 年至 2021 年，我们从机构审查委员会批准的数据库中确定了所有符合条件的接受回肠贮袋肛管吻合术和输入襻狭窄的连续患者。本研究纳入了接受输入襻狭窄切除和再植入/狭窄成形术的患者。
20 名患者符合纳入标准。15 名（75%）为女性，输入襻狭窄手术时的总体平均年龄为 41±10.3 岁。从回肠贮袋肛管吻合术到输入襻狭窄手术的间隔为 13.5±6.7 年。9 名（45%）接受了狭窄成形术，11 名（55%）接受了输入襻切除和再植入贮袋。在输入襻狭窄手术前，3 名（15%）患者因梗阻症状需要行转流性回肠造口术。另外 12 名（60%）在输入襻狭窄手术时构建了造口，其中 5 名患者进行了狭窄成形术且没有造口。术后，1 名（5%）患者输入襻狭窄修复部位出现漏。所有患者术后 3.2（2.99-3.6）个月关闭回肠造口。输入襻狭窄手术后长期随访，7 名（35%）患者在 3.9（2.6-5.8）年后再次出现小肠梗阻症状。
输入襻狭窄可以通过挽救性手术有效治疗。手术干预似乎持久，并为其梗阻症状提供了可接受的结果。
