Tabibian Kevin, Cho Nam Yong, Kwon Oh Jin, Aguayo Esteban, Ng Ayesha P, Obasohan Courtney, Yalzadeh Dariush, Chaturvedi Arjun, Benharash Peyman, Lee Hanjoo
Center for Advanced Surgical and Interventional Technology (CASIT), David Geffen School of Medicine, University of California, Los Angeles, California, United States of America.
Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2025 Jun 25;20(6):e0326963. doi: 10.1371/journal.pone.0326963. eCollection 2025.
Minimally invasive approach for reversal of Hartmann's procedure remains understudied. This study examined the outcomes associated with open and minimally invasive approaches for colostomy reversal in a national cohort.
The 2012-2022 American College of Surgeons National Surgical Quality Improvement Program participant use file data was queried to identify all adult (≥18 years) patients undergoing elective open or minimally invasive colostomy takedown. Multivariable regression models were developed to assess the associations between operative modalities and outcomes of interest, including overall complications (cardiac, respiratory, infectious, wound, renal and thromboembolic postoperative sequelae as well as reoperation and transfusion), operative duration, postoperative length of stay, and 30-day Readmissions.
Among the 20,163 patients who underwent colostomy takedown during the study period, 6,180 (30.7%) had a minimally invasive reversal. Utilization of minimally invasive colostomy reversal increased from 18.2% in 2012 to 41.9% in 2022 (nptrend < 0.001). Following risk adjustment, minimally invasive colostomy takedown was associated with reduced odds of overall complications compared to the open approach (AOR 0.56, 95% CI 0.51-0.62). The minimally invasive approach was associated with decremental operative duration by 16.9 minutes (95% CI 13.6 to 20.2 minutes) and postoperative length of stay by 1.70 days (95% CI 1.56 to 1.84 days), as well as decreased odds of 30-day readmission (AOR 0.75, 95% CI 0.67-0.85).
Over the past decade, utilization of minimally invasive colostomy reversal has more than doubled and yielded lower overall complication rates compared to the open approach. Our findings suggest that the minimally invasive approach may be appropriate for colostomy takedown in suitable cases.
哈特曼手术逆转的微创方法仍未得到充分研究。本研究在全国队列中考察了结肠造口术逆转的开放手术和微创手术方法的相关结果。
查询2012 - 2022年美国外科医师学会国家外科质量改进计划参与者使用文件数据，以识别所有接受择期开放或微创结肠造口回纳术的成年（≥18岁）患者。建立多变量回归模型以评估手术方式与感兴趣的结果之间的关联，包括总体并发症（心脏、呼吸、感染、伤口、肾脏和血栓栓塞性术后后遗症以及再次手术和输血）、手术持续时间、术后住院时间和30天再入院率。
在研究期间接受结肠造口回纳术的20163例患者中，6180例（30.7%）进行了微创逆转。微创结肠造口逆转的使用率从2012年的18.2%增至2022年的41.9%（趋势检验P<0.001）。经过风险调整后，与开放手术相比，微创结肠造口回纳术总体并发症的几率降低（调整后比值比0.56，95%置信区间0.51 - 0.62）。微创方法与手术持续时间减少16.9分钟（95%置信区间13.6至20.2分钟）、术后住院时间减少1.70天（95%置信区间1.56至1.84天）以及30天再入院几率降低（调整后比值比0.75，95%置信区间0.67 - 0.85）相关。
在过去十年中，微创结肠造口逆转的使用率增加了一倍多，与开放手术相比总体并发症发生率更低。我们的研究结果表明，在合适的病例中，微创方法可能适用于结肠造口回纳术。
