Ogino Takayuki, Sekido Yuki, Mizushima Tsunekazu, Fujii Makoto, Mori Ryota, Takeda Mitsunobu, Hata Tsuyoshi, Hamabe Atsushi, Miyoshi Norikatsu, Uemura Mamoru, Doki Yuichiro, Eguchi Hidetoshi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan.
Surg Today. 2025 May;55(5):638-645. doi: 10.1007/s00595-024-02944-5. Epub 2024 Oct 23.
Stoma outlet obstruction (SOO) is a serious complication of restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA). When the ileal mesentery to the pouch is under excessive tension, the ileum near the ileostomy twists easily, causing SOO. Loop-end ileostomy (EI) for fecal diversion was introduced in 2021 to prevent SOO, and we aimed to verify whether temporary EI reduces the incidence of SOO in RPC and IPAA patients relative to loop ileostomy (LI).
This study included 106 consecutive RPC and IPAA patients with a diverting ileostomy and categorized them into LI (n = 75) or EI (n = 31) groups. The clinical characteristics of the patients were analyzed and compared.
Patient characteristics were similar between the groups, except for higher preoperative steroid use in the LI group (38.7%; p = 0.0116). There were no significant differences between the groups in anatomical factors, such as abdominal wall thickness and the height-adjusted distance between the root of the superior mesenteric artery and the bottom of the external anal sphincter. There were no significant differences in surgery-related factors, with ≥ 90% of the patients in each group undergoing laparoscopic procedures. A multivariate logistic regression analysis revealed that EI significantly reduced the risk of SOO relative to LI (OR, 0.18; 95% CI 0.03-0.92; p = 0.0399).
EI reduced SOO levels after RPC and IPAA and may be beneficial for cases in which anastomosis is challenging.
造口出口梗阻（SOO）是直肠结肠切除术后恢复性直肠切除术（RPC）和回肠袋肛管吻合术（IPAA）的严重并发症。当通向袋体的回肠系膜张力过大时，回肠造口附近的回肠容易扭转，导致SOO。2021年引入了用于粪便转流的袢式末端回肠造口术（EI）以预防SOO，我们旨在验证相对于袢式回肠造口术（LI），临时EI是否能降低RPC和IPAA患者的SOO发生率。
本研究纳入了106例连续接受分流回肠造口术的RPC和IPAA患者，并将他们分为LI组（n = 75）或EI组（n = 31）。分析并比较了患者的临床特征。
两组患者的特征相似，但LI组术前使用类固醇的比例较高（38.7%；p = 0.0116）。两组在解剖学因素方面无显著差异，如腹壁厚度和肠系膜上动脉根部与肛门外括约肌底部之间的高度调整距离。手术相关因素也无显著差异，每组≥90%的患者接受了腹腔镜手术。多因素逻辑回归分析显示，相对于LI，EI显著降低了SOO的风险（OR，0.18；95%CI 0.03 - 0.92；p = 0.0399）。
EI降低了RPC和IPAA术后的SOO水平，可能对吻合具有挑战性的病例有益。
