Atraszkiewicz D, Shakir T, Harrington C, Bassett P, Soile B, Mukhtar H
Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, UK.
University College London, London, UK.
Colorectal Dis. 2025 Jun;27(6):e70137. doi: 10.1111/codi.70137.
To compare current UK surgical practice against evidence-based anastomotic evaluation techniques prior to ileostomy closure.
An online survey was distributed to UK consultant colorectal surgeons with Association of Coloproctology of Great Britain and Ireland affiliation to assess preoperative investigations. Data were collected at two timepoints: 2019 and 2024. A systematic review and meta-analysis were performed utilising PRISMA guidelines. MEDLINE (PubMed), Embase and Education Resources Information Center databases were evaluated from inception to 27 March 2024. Inclusion criteria were adult patients (≥18 years), distal colonic/pelvic anastomosis and defunctioning ileostomy reversal. ROBINS-I bias assessments were conducted. DerSimonian and Laird random-effects analyses were performed on eligible sensitivity and specificity data with forest plots generated.
CRD42024520236.
The survey received 221 (41.0%) and 212 (40.7%) responses in 2019 and 2024 respectively. Pre- and post-pandemic practice was consistent. Water-soluble contrast enema (WCE) and digital rectal examination (DRE) were the most utilised, performed 'always' by 83.2% and 78.7% respectively. Thirty-seven studies (5061 patients) were included for systematic review; 12 studies (1385 patients) for meta-analysis. Studies were heterogeneous in methodology; no randomised controlled trials were identified. Endoscopy showed higher sensitivity (73.1%) compared to retrograde contrast studies (WCE and pouchography; 53.1%) in identifying anastomotic leaks. Specificity was similar: 100% and 98.0% respectively. Significant heterogeneity and a lack of eligible studies limited further interpretation. CT has a limited evidence base for anastomotic evaluation.
The most commonly performed anastomotic evaluation methods in the UK are WCE and DRE. Endoscopy, however, has a greater sensitivity and specificity for identifying anastomotic complications. WCE is an effective option to confirm suspected leaks. Endoscopy should be considered to evaluate anastomotic integrity prior to ileostomy closure.
比较当前英国在回肠造口关闭术前的外科手术实践与基于证据的吻合口评估技术。
向隶属于大不列颠及爱尔兰结直肠外科学会的英国结直肠外科顾问医生开展一项在线调查，以评估术前检查情况。在两个时间点收集数据：2019年和2024年。利用PRISMA指南进行系统评价和荟萃分析。对MEDLINE（PubMed）、Embase和教育资源信息中心数据库从建库至2024年3月27日进行评估。纳入标准为成年患者（≥18岁）、远端结肠/盆腔吻合口以及功能性回肠造口还纳术。进行了ROBINS-I偏倚评估。对符合条件的敏感性和特异性数据进行DerSimonian和Laird随机效应分析，并生成森林图。
PROSPERO注册号：CRD42024520236。
该调查在2019年和2024年分别收到221份（41.0%）和212份（40.7%）回复。疫情前后的实践情况一致。水溶性造影剂灌肠（WCE）和直肠指检（DRE）是最常用的方法，分别有83.2%和78.7%的医生“总是”进行这两项检查。纳入37项研究（5061例患者）进行系统评价；纳入12项研究（1385例患者）进行荟萃分析。研究方法存在异质性；未识别到随机对照试验。在内镜检查中，在识别吻合口漏方面，其敏感性（73.1%）高于逆行造影检查（WCE和袋造影；53.1%）。特异性相似，分别为100%和98.0%。显著的异质性和缺乏符合条件的研究限制了进一步的解读。CT在吻合口评估方面的证据基础有限。
英国最常用吻合口评估方法是WCE和DRE。然而，在内镜检查在识别吻合口并发症方面具有更高的敏感性和特异性。WCE是确认疑似漏口的有效选择。在回肠造口关闭术前，应考虑采用内镜检查评估吻合口完整性。
