Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA.
Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
Surg Endosc. 2023 Aug;37(8):6538-6547. doi: 10.1007/s00464-023-10181-z. Epub 2023 Jun 12.
While endoscopic vacuum assisted closure (EVAC) therapy is a validated treatment for gastrointestinal leaks, its impact on long-term quality of life (QoL) is uncertain. The purpose of this study was to evaluate the impact of successful EVAC management on long-term QoL outcomes.
An institutional review board approved prospectively maintained database was retrospectively reviewed to identify patients undergoing treatment for gastrointestinal leaks between June 2012 and July 2022. The Short-Form 36 (SF-36) survey was used to assess QoL. Patients were contacted by telephone and sent the survey electronically. QoL outcomes between patients who underwent successful EVAC therapy and those who required conventional treatment (CT) were analyzed and compared.
A total of 44 patients (17 EVAC; 27 CT) completed the survey and were included in our analysis. All included patients had foregut leaks with sleeve gastrectomy being the most common sentinel operation (n = 20). The mean time from the sentinel operation was 3.8 years and 4.8 years for the EVAC and CT groups, respectively. When evaluating long-term QoL, the EVAC group scored higher in all QoL domains when compared to the CT group with physical functioning (87.3 vs 69.3, p = 0.04), role limitations due to physical health (84.1 vs 45.7, p = 0.02), energy/fatigue (60.0 vs 40.9, p = 0.04), and social functioning (86.2 vs 64.1, p = 0.04) reaching statistical significance. Overall, patients who achieved organ preservation via successful EVAC therapy scored higher in all domains with role limitations due to physical health (p = 0.04) being statistically significant. In a multivariable regression analysis, increased age and a history of prior abdominal surgery at the time of the sentinel operation were patient characteristics that negatively impacted QoL outcomes.
Patients with gastrointestinal leaks successfully managed by EVAC therapy have better long-term QoL outcomes when compared to patients undergoing other treatments.
虽然内镜下真空辅助闭合（EVAC）治疗是一种经过验证的胃肠道漏治疗方法，但它对长期生活质量（QoL）的影响尚不确定。本研究的目的是评估成功 EVAC 管理对长期 QoL 结局的影响。
回顾性分析了一家机构审查委员会批准的前瞻性维护数据库，以确定 2012 年 6 月至 2022 年 7 月期间接受胃肠道漏治疗的患者。采用简短 36 项健康调查量表（SF-36）评估 QoL。通过电话联系患者并通过电子邮件向其发送调查。分析并比较了接受成功 EVAC 治疗的患者和需要常规治疗（CT）的患者的 QoL 结果。
共有 44 名患者（EVAC 组 17 例，CT 组 27 例）完成了调查并纳入我们的分析。所有纳入的患者均有前肠漏，其中袖状胃切除术是最常见的哨兵手术（n=20）。EVAC 组和 CT 组从哨兵手术到接受治疗的平均时间分别为 3.8 年和 4.8 年。在评估长期 QoL 时，与 CT 组相比，EVAC 组在所有 QoL 领域的得分均更高，包括身体功能（87.3 对 69.3，p=0.04）、因身体健康受限的角色功能（84.1 对 45.7，p=0.02）、精力/疲劳（60.0 对 40.9，p=0.04）和社会功能（86.2 对 64.1，p=0.04），均具有统计学意义。总体而言，通过成功 EVAC 治疗保留器官的患者在所有领域的得分更高，其中因身体健康受限的角色功能差异具有统计学意义（p=0.04）。在多变量回归分析中，年龄增加和哨兵手术时存在既往腹部手术史是影响 QoL 结局的患者特征。
与接受其他治疗的患者相比，成功接受 EVAC 治疗的胃肠道漏患者具有更好的长期 QoL 结局。
