Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Tech Coloproctol. 2024 Feb 7;28(1):30. doi: 10.1007/s10151-023-02898-9.
Low anterior resection in patients with rectal cancer may require a defunctioning loop ileostomy formation that requires closure after a period of time. There are three common techniques for ileostomy closure: anterior repair (AR or fold-over closure), resection and hand-sewn anastomosis (RHA), and resection and stapled anastomosis (RSA). We aimed to compare them on the basis of operative and postoperative features.
Patients with rectal cancer who underwent low anterior resection without complications were included in this study and randomly assigned to three parallel groups to undergo loop ileostomy closure via either AR, RHA, or RSA. Early and late outcomes were gathered from all included patients.
Among 93 patients with a mean age of 56.21 ± 11.78 years, consisting of 58 (62.4%) men, 31 patients underwent AR, 30 patients RHA, and 32 patients RSA. There was no significant difference among the groups regarding the frequency and location of intraoperative injuries (P = 0.157). The AR groups demonstrated significantly less consumption of gauzes following intraoperative bleeding compared to the two others groups. The results showed that the duration of surgery in the RSA was significantly shorter than in the AR or RHA group (both P < 0.001). Regarding postoperative course, only one case of hematoma and two cases of surgical wound infection occurred in the RHA group. Anastomotic leakage and complete or partial obstruction did not occur in any group of patients. Latent postoperative complications did not occur in any group of patients. The median time between surgery and discharge as well as the interval until first gas passage, first defecation, oral tolerated liquid diet, as well as oral tolerated soft and regular diet in the AR group were significantly lower than in the two other groups (both P < 0.001). However, there was no statistical difference in these intervals between the RHA and RSA groups.
Resection and stapled anastomosis had the shortest duration among the three techniques; however, anterior repair had faster recovery, including earlier tolerated oral diet, gas passing and defecation, and discharge, in comparison with the other techniques.
Trial registration number IRCT20120129008861N5.
直肠癌患者行低位前切除术时可能需要形成预防性回肠造口术，一段时间后需要关闭。回肠造口术有三种常见的关闭技术：前修复术（AR 或折叠关闭术）、切除和手工吻合术（RHA）以及切除和吻合器吻合术（RSA）。我们旨在根据手术和术后特征对它们进行比较。
本研究纳入了低位前切除术后无并发症的直肠癌患者，并将他们随机分为三组，分别通过 AR、RHA 或 RSA 行预防性回肠造口术关闭。从所有纳入的患者中收集早期和晚期结局。
在 93 例平均年龄为 56.21±11.78 岁（其中 58 例为男性）的患者中，31 例患者行 AR，30 例患者行 RHA，32 例患者行 RSA。三组术中损伤的频率和部位无显著差异（P=0.157）。与另外两组相比，AR 组术中出血后纱布消耗明显较少。结果显示，RSA 组的手术时间明显短于 AR 或 RHA 组（均 P<0.001）。关于术后过程，只有 RHA 组发生 1 例血肿和 2 例手术伤口感染。任何一组患者均未发生吻合口漏或完全或部分梗阻。任何一组患者均未发生潜伏性术后并发症。AR 组的手术与出院之间的中位时间以及首次排气、首次排便、口服耐受液体饮食、口服耐受软质常规饮食的间隔时间均显著低于另外两组（均 P<0.001）。然而，RHA 和 RSA 组之间这些间隔时间无统计学差异。
三种技术中，切除和吻合器吻合术的手术时间最短；然而，与其他技术相比，前修复术的恢复更快，包括更早耐受口服饮食、排气和排便以及出院。
试验注册号 IRCT20120129008861N5。
