Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin, Ireland.
Tech Coloproctol. 2024 Nov 22;29(1):1. doi: 10.1007/s10151-024-03035-w.
Since the ileal pouch anal anastomosis (IPAA) was first described, anorectal manometry (ARM) has been used to study its physiology and function. Few studies have investigated if preoperative ARM can predict pouch function.
Pubmed, EMBASE, and the Cochrane Library databases were systematically searched. Papers detailing preoperative ARM results and postoperative functional outcomes of patients with IPAA were included. Meta-analysis with meta-regression was performed, assessing the relationship between preoperative manometric results and objective postoperative functional outcomes including frequency, seepage, pad usage and medications, and functional scoring systems including Wexner Incontinence and Oresland Scores.
Results from 31 studies were analysed. Mean resting pressure (MRP) decreased significantly (- 23.16 mmHg, 95% CI - 27.98 to - 18.35, p < 0.01) after pouch formation but before ileostomy reversal, with subsequent minor increase (3.51 mmHg, 95% CI 0.93 to 6.09, p = 0.01) by 6 months after reversal of ileostomy. Pooled bowel frequency was 5.4 per 24 h (4.90-5.91), day and night-time soiling, incontinence, and pad usage rates were 16% (9-24%), 26% (19-33%), 12% (4-20%), and 21% (13-30%) respectively. Pooled Oresland and Wexner Scores were 3.81 (2.92-4.70) and 3.45 (2.71-4.19). A significant association between preoperative MRP and Wexner Score was observed (p < 0.001). As a result of risk of bias, study heterogeneity, and variation in manometry systems, certainty of evidence was low or very low.
Preoperative predictors of function inform patient and clinician decision-making. Further investigations into the association between preoperative MRP and Wexner Score using modern ARM techniques are warranted.
自从回肠贮袋肛管吻合术（IPAA）首次被描述以来，直肠测压术（ARM）已被用于研究其生理和功能。很少有研究调查术前 ARM 是否可以预测贮袋功能。
系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库。纳入了详细描述 IPAA 患者术前 ARM 结果和术后功能结果的论文。进行了荟萃分析和荟萃回归分析，评估了术前测压结果与术后客观功能结果（包括频率、渗漏、使用尿垫和药物以及功能评分系统，包括 Wexner 失禁评分和 Oresland 评分）之间的关系。
分析了 31 项研究的结果。贮袋形成后但在回肠造口还纳前，平均静息压（MRP）显著降低（-23.16mmHg，95%CI-27.98 至-18.35，p<0.01），随后在回肠造口还纳后 6 个月略有增加（3.51mmHg，95%CI0.93 至 6.09，p=0.01）。 pooled bowel frequency 为 24 小时 5.4 次（4.90-5.91），白天和夜间排便、失禁和使用尿垫的发生率分别为 16%（9-24%）、26%（19-33%）、12%（4-20%）和 21%（13-30%）。 pooled Oresland 和 Wexner 评分分别为 3.81（2.92-4.70）和 3.45（2.71-4.19）。术前 MRP 与 Wexner 评分之间存在显著相关性（p<0.001）。由于偏倚风险、研究异质性和测压系统的变化，证据确定性为低或极低。
功能的术前预测指标可告知患者和临床医生的决策。需要进一步研究使用现代 ARM 技术，术前 MRP 与 Wexner 评分之间的关系。
