Department of Digestive and General Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne University, Paris, France.
Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.
Colorectal Dis. 2024 Nov;26(11):1931-1940. doi: 10.1111/codi.17196. Epub 2024 Oct 3.
Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch-anal anastomosis (IPAA).
This was a retrospective study including all patients operated (2015-2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health-related QoL was evaluated with the SF-36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL.
Among 179 eligible patients, 150 responded (84%): S- (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S- and S+ group, respectively: 18 [12.5-31] versus 18 [11-31], p = 0.48 for LARS; 9 [7-11] versus 9 [7-12], p = 0.23 for Wexner's score; 6 [3-13] versus 8 [5-11], p = 0.22 for Öresland's score, 6 [3-13] versus 6.8 [4-12], p = 0.174 for PFS score, and 40 [35-45] versus 46 [42-51], p = 0.045 for IPSS score. The SF-36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001).
DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients.
在某些患者中，可以省略直肠结肠切除术后的回肠造口术（DS）。已经在接受直肠切除术的患者中证明，省略回肠造口术可以改善功能结果和生活质量（QoL）。本研究的目的是报告回肠贮袋肛管吻合术（IPAA）后回肠造口术对功能结果和生活质量的影响。
这是一项回顾性研究，纳入了所有接受直肠结肠切除术和 IPAA 手术的患者（2015-2020 年）。通过有效的评分（LARS、Wexner、Öresland、贮袋功能评分[PFS]和回肠肛袋综合征严重程度评分[IPSS]）评估功能结果。使用 SF-36 评估全球健康相关 QoL。我们还分析了人口统计学特征、发病率、功能结果和 QoL 之间的相关性。
在 179 名符合条件的患者中，有 150 名（84%）做出了回应：S-（无造口=78；52%）和 S+（有造口=72；48%）。两组患者的总发病率和吻合口漏率分别为 46%和 9.3%，无差异。S-组和 S+组的功能评分中位数相似，分别为：18[12.5-31]与 18[11-31]，p=0.48 用于 LARS；9[7-11]与 9[7-12]，p=0.23 用于 Wexner 评分；6[3-13]与 8[5-11]，p=0.22 用于Öresland 评分，6[3-13]与 6.8[4-12]，p=0.174 用于 PFS 评分，40[35-45]与 46[42-51]，p=0.045 用于 IPSS 评分。两组的 SF-36 综合评分相当，在八个特定健康维度方面没有差异。在进行倾向评分匹配后，两组之间的所有评分结果仍然相似。线性回归发现所有 QoL 领域与所有功能评分均呈显著相关性（p<0.001）。
IPAA 中的 DS 不会改变功能结果或生活质量，可以在选定的患者中省略。
