Metzger Daniel Aryeh, Mesiti Andrea, Johnson Josh, Li Ying, Brouwer Julianna, Manasa Morgan, Lee Sarah, Hsu Angela, Jafari Mehraneh D, Pigazzi Alessio
Department of Surgery, New York-Presbyterian/Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA.
Department of Public Health, NY-Presbyterian/Weill Cornell Medicine, New York, NY, USA.
Surg Endosc. 2025 Apr;39(4):2436-2442. doi: 10.1007/s00464-025-11574-y. Epub 2025 Feb 20.
There is limited data on pouch outcomes after minimally invasive (MIS) proctectomy during ileal pouch-anal anastomosis (IPAA). This study aimed to determine if MIS proctectomy is associated with differences in pouch complications compared to open.
We performed a retrospective cohort study of patients from two academic institutions (2010-2022) who underwent restorative proctectomy with IPAA for inflammatory bowel disease, excluding those with Crohn's disease or Crohn's-like disease of the pouch. Patients were categorized into Open and MIS groups based on surgical approach. Perioperative outcomes and rates of pouchitis, cuffitis, and pouch failure were compared. Patient, disease, and operative factors associated with risk of pouch complications were identified using multivariable regression.
117 patients were included: 36 MIS and 81 Open. Median age at colectomy was 35 years, and 60% were male. Demographics, preoperative symptoms, medications, and surgical indications were comparable between groups. Rates of pouchitis (MIS 37% vs. Open 45%; p = 0.4), cuffitis (32% vs. 27%; p = 0.5), and pouch failure (5.6% vs. 6.2%; p > 0.9) were similar. MIS was associated with lower estimated blood loss (median 75 cc vs. 150 cc; p < 0.001). There were no differences in length of stay (MIS: 5 days vs. Open: 6 days; p = 0.2), operative time, or 30-day postoperative complications (HR 1.41; p = 0.5). There was a trend toward fewer anastomotic leaks in the MIS group (2.1% vs. 9.7%; p-0.2). On multivariable analysis, only initial colectomy for an indication of acute severe ulcerative colitis (HR 6.21; p = 0.044) and 5 bowel movements per day preoperatively (HR 3.58; 95% CI 1.10-13.1; p-0.041) were significantly associated with risk of pouchitis or cuffitis.
MIS proctectomy is associated with equivalent long-term pouch outcomes compared to open proctectomy. There may be a reduced risk of anastomotic leak with MIS and other perioperative outcomes were similar between groups. Patient and disease factors, but not operative factors, were associated with risk of pouch complications.
关于在回肠储袋肛管吻合术（IPAA）期间进行微创（MIS）直肠切除术后的储袋结局的数据有限。本研究旨在确定与开放手术相比，MIS直肠切除术是否与储袋并发症的差异相关。
我们对来自两个学术机构（2010 - 2022年）因炎症性肠病接受IPAA恢复性直肠切除术的患者进行了一项回顾性队列研究，排除患有克罗恩病或储袋类克罗恩病的患者。根据手术方式将患者分为开放手术组和MIS组。比较围手术期结局以及袋炎、袖口炎和储袋失败的发生率。使用多变量回归确定与储袋并发症风险相关的患者、疾病和手术因素。
纳入117例患者：36例MIS手术患者和81例开放手术患者。结肠切除术时的中位年龄为35岁，60%为男性。两组之间的人口统计学、术前症状、药物治疗和手术指征具有可比性。袋炎发生率（MIS组37% vs. 开放手术组45%；p = 0.4）、袖口炎发生率（32% vs. 27%；p = 0.5）和储袋失败发生率（5.6% vs. 6.2%；p > 0.9）相似。MIS手术与估计失血量较低相关（中位75 cc vs. 150 cc；p < 0.001）。住院时间（MIS组：5天 vs. 开放手术组：6天；p = 0.2）、手术时间或术后30天并发症发生率无差异（风险比1.41；p = 0.5）。MIS组吻合口漏的发生率有降低趋势（2.1% vs. 9.7%；p = 0.2）。在多变量分析中，仅因急性重症溃疡性结肠炎而进行初次结肠切除术（风险比6.21；p = 0.044）和术前每天排便5次（风险比3.58；95%置信区间1.10 - 13.1；p = 0.041）与袋炎或袖口炎风险显著相关。
与开放直肠切除术相比，MIS直肠切除术具有相当的长期储袋结局。MIS手术可能降低吻合口漏的风险，且两组之间的其他围手术期结局相似。患者和疾病因素而非手术因素与储袋并发症风险相关。
