Herman Koby, Nemeth Samantha, Shen Bo, Church James M, Kiran Ravi P
New York-Presbyterian/Columbia University Irving Medical Center, Colorectal Surgery, 161 Ft. Washington Ave. 8 Fl, New York, NY, 10032.
Surg Pract Sci. 2022 Jul 23;10:100114. doi: 10.1016/j.sipas.2022.100114. eCollection 2022 Sep.
Previous literature related to postoperative outcomes after laparoscopic vs. open ileal pouch-anal anastomosis (IPAA) is primarily based on small numbers of patients from single institutions. The aim of this study is to evaluate these outcomes in a large number of patients using propensity score matching (PSM).
The ACS-NSQIP Program data files (2016-2019) were reviewed to identify patients who underwent an IPAA creation. The impact of surgical approach on operative and postoperative outcomes were evaluated. 1:1 propensity score matching (PSM) on all patient characteristics was used to obtain matched groups. Fisher's Exact/Chi-Squared tests were used to compare outcomes between groups. A Bonferroni correction was applied to the outcomes, with a p-value of 0.0031 representing statistical significance.
1802 patients were identified, with 1001 patients in the laparoscopic group and 801 patients in the open group. PSM yielded 702 patients in each matched group. Median operative time was longer for laparoscopic IPAA (278vs218.5 minutes, p<0.001). Laparoscopic IPAA patients were less likely to develop superficial and deep SSIs (3.0% vs 6.6% p=0.003). There were no differences in in-hospital mortality (0.4% vs 0.0%, p=0.3), anastomotic leak (4.0% vs 3.3%, p=1.0), organ-space SSI (6.7% vs 6.0, p=1.0), or reoperation (5.7% vs 4.0%, p=0.2) between groups. Length of stay was lower after laparoscopic IPAA (5.0 vs 6.0 days, p=0.004). There were no differences between groups in other postoperative complications.
These data suggest that when matched for other confounding variables, laparoscopic IPAA is associated with reduced length of stay and superficial/deep SSIs when compared to open IPAA. Other surgical complications, including in-hospital mortality and anastomotic leak, are similar.
Given the recovery benefit of the laparoscopic approach and the reduced SSI, laparoscopy should be the method of choice for the majority of patients undergoing IPAA.
先前有关腹腔镜与开放回肠储袋肛管吻合术（IPAA）术后结局的文献主要基于来自单一机构的少量患者。本研究的目的是使用倾向评分匹配（PSM）方法评估大量患者的这些结局。
回顾美国外科医师学会国家外科质量改进计划（ACS-NSQIP）项目数据文件（2016 - 2019年），以确定接受IPAA手术的患者。评估手术方式对手术及术后结局的影响。对所有患者特征进行1:1倾向评分匹配（PSM）以获得匹配组。采用Fisher精确检验/卡方检验比较组间结局。对结局应用Bonferroni校正，p值为0.0031表示具有统计学意义。
共识别出1802例患者，其中腹腔镜组1001例，开放组801例。PSM后每个匹配组有702例患者。腹腔镜IPAA的中位手术时间更长（278对218.5分钟，p<0.001）。腹腔镜IPAA患者发生浅表和深部手术部位感染（SSI）的可能性较小（3.0%对6.6%，p = 0.003）。两组在住院死亡率（0.4%对0.0%，p = 0.3）、吻合口漏（4.0%对3.3%，p = 1.0）、器官腔隙SSI（6.7%对6.0，p = 1.0）或再次手术（5.7%对4.0%，p = 0.2）方面无差异。腹腔镜IPAA后的住院时间更短（5.0对6.0天，p = 0.004）。两组在其他术后并发症方面无差异。
这些数据表明，在对其他混杂变量进行匹配后，与开放IPAA相比，腹腔镜IPAA与住院时间缩短及浅表/深部SSI减少相关。其他手术并发症，包括住院死亡率和吻合口漏，相似。
鉴于腹腔镜手术方式在恢复方面的益处以及SSI的减少，腹腔镜手术应成为大多数接受IPAA患者的首选方法。
