Liu Wei-Hang, Xiong Mao, Chen Guo-Qing, Long Zhui, Xu Chao, Zhu Li, Wu Jing-Song
Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):98269. doi: 10.4240/wjgs.v17.i1.98269.
There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR).
To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD.
This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.
Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay ( = 0.045), lower incidence of enteral nutrition intolerance symptoms ( = 0.019), and earlier postoperative total enteral nutrition initiation ( = 0.033); however, it incurred higher total hospital costs ( = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance ( < 0.05).
Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.
腹腔镜体内吻合技术日益成熟。然而，其在克罗恩病（CD）患者小肠造口回纳中的应用研究有限。因此，在本研究中，我们比较了腹腔镜体内回肠造口回纳术（LIIR）和开放回肠造口回纳术（OIR）的围手术期结局。
比较CD患者LIIR和OIR的安全性、可行性、肠功能恢复情况以及短期和长期结局。
本研究纳入了2021年1月至2023年1月在我院因CD接受回肠造口回纳术的患者。对基线数据、术后恢复情况和并发症指标进行回顾性分析。进行逻辑回归分析以探讨显著影响肠内营养不耐受相关症状发生的因素。
值得注意的是，本研究45例患者中有15例行OIR，其余30例行LIIR。值得注意的是，两组在临床基线特征、手术时间、术中出血、吻合部位、肠粘连松解范围、术后首次排气、术后并发症、再次手术率或术后肠内营养不耐受发生率方面均未发现统计学显著差异。与OIR组相比，LIIR组术后住院时间更短（P = 0.045），肠内营养不耐受症状发生率更低（P = 0.019），术后全肠内营养开始时间更早（P = 0.033）；然而，其总住院费用更高（P = 0.038）。此外，多因素逻辑回归分析显示手术时间和吻合技术是术后肠内营养不耐受症状的独立危险因素（P < 0.05）。
腹腔镜体内吻合回肠造口回纳术安全可行。接受该技术的患者术后对肠内营养的耐受性提高，全肠内营养恢复更快。
