Akdeniz University Hospital, Antalya, Türkiye.
Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA.
Langenbecks Arch Surg. 2024 Aug 9;409(1):247. doi: 10.1007/s00423-024-03404-x.
Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks.
In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation.
In total, 168 patients were included. The median age of the patients was 38 years (IQR 27-51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41-61] vs. 37 [IQR 27-50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006).
Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery.
克罗恩病可能表现为复杂的手术病理，给患者带来显著的发病率和死亡率风险。对某些患者实施回肠袢式造口术可能有助于最大限度地降低相关风险。
在这项回顾性队列研究中，我们研究了在克罗恩病手术中通过创建回肠袢式造口术来实现临时粪便转流的应用。所有造口的关闭均采用手工单层缝合技术。然后，我们对 30 天内的关闭结果进行了双变量分析，重点关注有利的恢复，定义为在没有发生以下两种恢复挑战的情况下恢复肠道连续性：新出现的器官功能障碍或需要再次手术。
共纳入 168 例患者。患者的中位年龄为 38 岁（IQR 27-51）。造口的最常见指征是腹膜炎（49%）。在回肠造口关闭后，163 例（97%）患者实现了有利的恢复，而 5 例患者遇到了挑战；其中 4 例（2.4%）接受了腹部手术，1 例（0.6%）发生急性肾衰竭需要透析。有 2 例（1.2%）患者重新创建了回肠造口。遇到挑战的患者年龄更大（56 [IQR 41-61] 岁 vs. 37 [IQR 27-50] 岁；p=0.039），更常需要二期愈合（40% vs. 6.7%；p=0.049）和术后肠外营养（83% vs. 26%；p=0.006）。
选择性分期克罗恩病手术并采用回肠袢式造口术是一种可靠的做法，具有较低的发病率和较高的肠连续性恢复率。我们的手工单层缝合技术在实现成功的手术恢复方面证明是有效的。
