Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Division of Colon and Rectal Surgery, Institute for Treatment and Research (IRCCS) Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy; Division of Colon and Rectal Surgery, Institute for Treatment and Research (IRCCS) Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan, Italy.
Surgery. 2023 Oct;174(4):808-812. doi: 10.1016/j.surg.2023.06.027. Epub 2023 Jul 28.
Ileal pouch-anal anastomosis is most commonly performed by double-stapling technique after rectal transection with a linear stapler. Double-stapling is increasingly criticized for the uneven longer cuffs and potential weak points. A transanal rectal transection and single-stapled anastomosis may potentially overcome the limitations of double-stapling. A single-stapled anastomosis may be accomplished through a transanal rectal transection followed by bottom-up dissection (transanal-ileal pouch-anal anastomosis) or through an abdominal, rectal dissection and subsequent transanal transection and single-stapled anastomosis. The purpose of this study is to compare short-term and functional outcomes of double-stapling versus single-stapled techniques for ileal pouch-anal anastomosis.
This is a single-institution, ambidirectional study. Patients with ulcerative colitis undergoing ileal pouch-anal anastomosis between 2014 and 2021 were included in the study and allocated into 2 groups: group 1, including double stapled ileal pouch anal anastomosis, and group 2, including single-stapled-ileal pouch-anal anastomosis. The primary endpoint was the difference in functional parameters.
A total of 130 patients were included, 46 undergoing double-stapling-ileal pouch-anal anastomosis and 84 receiving single-stapled ileal pouch-anal anastomosis. Rectal-cuff length (defined as the distance between the dentate line and ileal pouch-anal anastomosis) was shorter after single-stapled compared with double-stapling ileal pouch-anal anastomosis (1.98 ± 0.21 vs 2.20 ± 0.53 cm, P = .01). Anastomotic leak rate was comparable between group 1 and group 2 (6% vs 5%, P = .69). Functional parameters were comparable except for urgency, which was lower for single-stapled compared with double-stapling ileal pouch-anal anastomosis (8%, vs 30%, P = .002).
Single-stapled ileal pouch-anal anastomosis was associated with a shorter rectal cuff and lower urgency than double-stapling ileal pouch-anal anastomosis. In our opinion, these results warrant a prospective multicentric trial to scrutinize and confirm these benefits on a larger scale.
经直肠直线吻合器行直肠横断后，最常采用双吻合器技术行回肠袋肛管吻合术。双吻合器技术因吻合口较长且不均匀以及潜在的薄弱点而受到越来越多的批评。经肛直肠横断和单吻合器吻合术可能会克服双吻合器的局限性。单吻合器吻合术可通过经肛直肠横断和由下至上的分离（经肛-回肠袋-肛管吻合术）或通过腹部、直肠的分离和随后的经肛直肠横断和单吻合器吻合术来完成。本研究的目的是比较双吻合器与单吻合器技术行回肠袋肛管吻合术的短期和功能结果。
这是一项单中心、双向研究。纳入 2014 年至 2021 年期间接受回肠袋肛管吻合术的溃疡性结肠炎患者，并将其分为两组：组 1 为双吻合器回肠袋肛管吻合术，组 2 为单吻合器回肠袋肛管吻合术。主要终点是功能参数的差异。
共纳入 130 例患者，其中 46 例行双吻合器回肠袋肛管吻合术，84 例行单吻合器回肠袋肛管吻合术。单吻合器组的直肠袖口长度（定义为齿状线和回肠袋肛管吻合口之间的距离）明显短于双吻合器组（1.98 ± 0.21 比 2.20 ± 0.53cm，P =.01）。组 1 和组 2 的吻合口漏发生率相当（6%比 5%，P =.69）。两组的功能参数除了紧迫性外，其余参数均相似，单吻合器组的紧迫性明显低于双吻合器组（8%比 30%，P =.002）。
与双吻合器回肠袋肛管吻合术相比，单吻合器回肠袋肛管吻合术的直肠袖口较短，且紧迫性较低。在我们看来，这些结果需要前瞻性多中心试验来更详细地检查和确认这些益处。
