Lee Jong Lyul, Yoon Yong Sik, Lee Hyun Gu, Kim Young Il, Kim Min Hyun, Kim Chan Wook, Park In Ja, Lim Seok-Byung, Yu Chang Sik
Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
Department of Surgery, Gangdong Kyung Hee University Hospital, Seoul 05278, South Korea.
World J Gastrointest Surg. 2024 Aug 27;16(8):2592-2601. doi: 10.4240/wjgs.v16.i8.2592.
Medical treatment for Crohn's disease (CD) has continuously improved, which has led to a decrease in surgical recurrence rates. Despite these advancements, 25% of patients will undergo repeat intestinal surgery. Recurrence of CD commonly occurs on the mesentery side of the anastomosis site.
To compare the new anti-mesenteric side-to-side delta-shaped stapled anastomosis (DSA) with the conventional stapled functional end-to-end anastomosis (CSA).
This retrospective study included CD patients who underwent ileo-ileal or ileo-colic anastomosis between January 2020 and December 2023. The DSA technique employed a stapler to maintain the concept of anti-mesentery side-to-side anastomosis by performing a 90° vertical closure of the open window compared with the CSA technique. At the corner where the open window is closed, the DSA avoids forming a pouch and creates an anastomosis resembling a delta shape within the intestinal lumen. We compared demographics, preoperative condition, operative findings, and operative outcomes for the two techniques.
The study included 175 patients, including 92 in the DSA group and 83 in the CSA group. The two groups were similar in baseline characteristics, preoperative medical treatment, and operative findings except for the Montreal classification location. The 30-days postoperative complication rate was significantly lower in the DSA group compared with the CSA group (16.3% 32.5%, = 0.009). Ileus incidence was significantly lower in the DSA group than in the CSA group (4.3% 14.5%, = 0.033), and the hospital stay was shorter in the DSA group than in the CSA group (5.67 ± 1.53 days 7.39 ± 3.68 days, = 0.001).
The DSA technique was feasible and showed comparable postoperative outcomes with lower short-term complications compared with the CSA technique. Further studies on CD recurrence and long-term complications are warranted.
克罗恩病（CD）的医学治疗不断改进，这导致手术复发率下降。尽管有这些进展，但仍有25%的患者需要接受再次肠道手术。CD复发通常发生在吻合口系膜侧。
比较新型抗系膜侧侧三角吻合术（DSA）与传统吻合器功能性端端吻合术（CSA）。
这项回顾性研究纳入了2020年1月至2023年12月期间接受回肠-回肠或回肠-结肠吻合术的CD患者。与CSA技术相比，DSA技术使用吻合器通过对开窗进行90°垂直闭合来维持抗系膜侧侧吻合的概念。在开窗闭合的角部，DSA避免形成袋状，并在肠腔内形成类似三角形的吻合。我们比较了两种技术的人口统计学、术前状况、手术发现和手术结果。
该研究纳入了175例患者，其中DSA组92例，CSA组83例。除蒙特利尔分类位置外，两组在基线特征、术前治疗和手术发现方面相似。DSA组术后30天并发症发生率显著低于CSA组（16.3%对32.5%，P = 0.009）。DSA组肠梗阻发生率显著低于CSA组（4.3%对14.5%，P = 0.033），且DSA组住院时间短于CSA组（5.67±1.53天对7.39±3.68天，P = 0.001）。
DSA技术可行，与CSA技术相比，术后结果相当，短期并发症更少。有必要对CD复发和长期并发症进行进一步研究。
