Sarangi Yajnadatta, Kumar Ashok, Malage Somanath, Ghosh Nalinikanta, Rahul Rahul, Singh Ashish, Sharma Supriya, Singh Rajneesh K, Behari Anu, Kumar Ashok
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND.
Cureus. 2024 Dec 4;16(12):e75086. doi: 10.7759/cureus.75086. eCollection 2024 Dec.
Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is often considered the preferred surgical treatment for ulcerative colitis. This study was conducted to investigate the early and late complications of ileal pouch-anal anastomosis in patients with ulcerative colitis, as well as the factors associated with these complications. Methodology All relevant clinical and operative data of patients (n = 101) who underwent IPAA for ulcerative colitis between January 1995 and December 2018 were retrieved from a prospectively maintained database. Early complications, various late complications, and their predictive factors were studied. Results A total of 101 patients underwent IPAA. Early complications (≤30 days) occurred in 72 (71.3%) patients, mostly Clavien-Dindo grades 1 and 2. No significant risk factors were associated with early complications. Among the late complications, pouchitis was the most common complication (n = 37, 36.6%), followed by anastomotic stricture (n = 27, 26.7%). Pouch failure was seen in 11 (10.9%) patients. No significant factors were found to be associated with the development of pouchitis. Pelvic sepsis (odds ratio (OR) = 2.704, 95% confidence interval (CI) = 1.041-7.022, p = 0.041) and handsewn anastomosis (OR = 3.943, 95% CI = 1.093-14.229, p = 0.036) were significantly related to the development of anastomotic stricture and pouch-vaginal fistulae, respectively. Conclusions The most common early and late complications following IPAA were pelvic sepsis and pouchitis, respectively. These complications were managed successfully with an acceptable pouch failure rate. No predictive factor was found to be significant with early complications. However, pelvic sepsis and hand-sewn anastomosis were associated with stricture formation and pouch vaginal fistulae, respectively.
背景 回肠袋肛管吻合术（IPAA）进行的结直肠全切除术常被认为是溃疡性结肠炎的首选手术治疗方式。本研究旨在调查溃疡性结肠炎患者回肠袋肛管吻合术的早期和晚期并发症，以及与这些并发症相关的因素。方法 从一个前瞻性维护的数据库中检索了1995年1月至2018年12月期间因溃疡性结肠炎接受IPAA手术的患者（n = 101）的所有相关临床和手术数据。研究了早期并发症、各种晚期并发症及其预测因素。结果 共有101例患者接受了IPAA手术。72例（71.3%）患者发生早期并发症（≤30天），大多为Clavien-Dindo 1级和2级。早期并发症无显著相关危险因素。在晚期并发症中，袋炎是最常见的并发症（n = 37，36.6%），其次是吻合口狭窄（n = 27，26.7%）。11例（10.9%）患者出现袋功能衰竭。未发现与袋炎发生相关的显著因素。盆腔感染（比值比（OR）= 2.704，95%置信区间（CI）= 1.041 - 7.022，p = 0.041）和手工缝合吻合术（OR = 3.943，95% CI = 1.093 - 14.229，p = 0.036）分别与吻合口狭窄和袋阴道瘘的发生显著相关。结论 IPAA术后最常见的早期和晚期并发症分别是盆腔感染和袋炎。这些并发症通过可接受的袋功能衰竭率得到了成功处理。未发现早期并发症有显著的预测因素。然而，盆腔感染和手工缝合吻合术分别与狭窄形成和袋阴道瘘相关。
