Coste Marine, Cao Sarah, Kayal Maia, Wang Yun Hwa Walter, Hahn Sue J, Khaitov Sergey, Sylla Patricia A, Dubinsky Marla C, Plietz Michael C, Greenstein Alexander J
Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Surg Endosc. 2025 Jan;39(1):624-631. doi: 10.1007/s00464-024-11378-6. Epub 2024 Nov 4.
Small bowel obstructions (SBOs) are a common complication following staged IPAA. Our goal was to compare early post-operative SBO outcomes between different staged ileal pouch-anal anastomosis (IPAA) and to further analyze the type of procedures required in patients who needed operative management of SBO.
In this retrospective cohort study, we selected all patients who presented to our tertiary care center between 2008 and 2017, with ulcerative colitis or IBD-Unspecified colitis and who underwent a primary total proctocolectomy with IPAA for medically refractory disease or dysplasia (n = 623). Patients were divided into 4 groups based on staged IPAA received (1 stage vs 2 stage vs modified 2 stage vs 3 stage). Primary outcomes were compared between both groups using univariate analysis and included SBO within 6 months post-operatively of one of the IPAA stages or 18 months since the first surgery for patients who underwent 1 or 2 stage IPAAs, and need for readmission and reoperation. Risk factors for SBO, reoperation and readmission due to SBO were evaluated using multivariate logistic regression.
Stage 2 and 3 patients had the highest rates of SBO post-operatively. There was a significant difference in the rate of readmission between groups, with 2 and 3 stage groups having the highest rates (p < 0.05) but the rate of SBO and reoperations was not significantly different between groups. Of all patients with an SBO, 34% required operative intervention. Of these, 65% underwent diagnostic laparoscopy with lysis of adhesions and 27% required an open procedure.
Small bowel obstructions are a common complication of staged IPAA procedures. Patients who underwent 2 and 3 stage IPAA had the highest rates of SBO, although not statistically significant. A third of patients with an SBO required surgical intervention, with diagnostic laparoscopy and lysis of adhesions being the most common procedure.
小肠梗阻（SBO）是分期回肠袋肛管吻合术（IPAA）后的常见并发症。我们的目标是比较不同分期回肠袋肛管吻合术（IPAA）术后早期SBO的结局，并进一步分析需要对SBO进行手术治疗的患者所需的手术类型。
在这项回顾性队列研究中，我们选取了2008年至2017年间到我们三级医疗中心就诊、患有溃疡性结肠炎或未明确类型的炎症性肠病（IBD）结肠炎、因药物难治性疾病或发育异常接受了初次全直肠结肠切除术及IPAA的所有患者（n = 623）。根据接受的分期IPAA将患者分为4组（1期 vs 2期 vs 改良2期 vs 3期）。使用单因素分析比较两组的主要结局，包括IPAA分期之一术后6个月内或接受1期或2期IPAA手术的患者首次手术后18个月内发生的SBO，以及再次入院和再次手术的需求。使用多因素逻辑回归评估SBO、再次手术和因SBO再次入院的危险因素。
2期和3期患者术后SBO发生率最高。各组之间再次入院率存在显著差异，2期和3期组再次入院率最高（p < 0.05），但各组之间SBO和再次手术率无显著差异。在所有发生SBO的患者中，34% 需要手术干预。其中，65% 接受了诊断性腹腔镜粘连松解术，27% 需要进行开放手术。
小肠梗阻是分期IPAA手术的常见并发症。接受2期和3期IPAA手术的患者SBO发生率最高，尽管无统计学意义。三分之一的SBO患者需要手术干预，诊断性腹腔镜粘连松解术是最常见的手术方式。
