Horio Yuki, Uchino Motoi, Kiriki Masato, Tomoo Yusuke, Nomura Kazunori, Nagano Kentaro, Kusunoki Kurando, Kuwahara Ryuichi, Kimura Kei, Kataoka Kozo, Ikeda Masataka, Ikeuchi Hiroki
Department of Gastroenterological Surgery, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya CityHyogo, 663-8501, Japan.
Department of Radiological Technology, Hyogo Medical University Hospital, Nishinomiya CityHyogo, 663-8501, Japan.
Int J Colorectal Dis. 2025 Sep 12;40(1):197. doi: 10.1007/s00384-025-04990-y.
Obesity has been reported to increase the risk of technical inability in performing ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to prospectively investigate the association between visceral fat and the feasibility of pouch reach in hand-sewn IPAA.
We prospectively enrolled patients with UC scheduled for two-stage restorative proctocolectomy with a preoperative plan for hand-sewn IPAA. Patients were categorized into a conversion group that required conversion to stapled IPAA intraoperatively and a non-conversion group. Preoperative visceral fat area and anatomical indicators were measured using computed tomography (CT). Logistic regression analysis was performed to identify predictors of conversion surgery.
A total of 106 patients were included, with 12 (11.3%) in the conversion group. Compared with those in the non-conversion group, patients in the conversion group had significantly higher body mass index (BMI), greater visceral fat, and a longer distance between the ileal end and the anal verge (p < 0.01). Logistic regression identified visceral fat (per 10 cm increase: odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.01) as a significant predictor of conversion surgery, whereas BMI was not (OR 1.03, 95% CI 0.77-1.21, p = 0.72).
Visceral fat is an independent risk factor for conversion surgery in patients undergoing hand-sewn IPAA. Preoperative CT-based measurement of visceral fat may provide a more accurate prediction of pouch reachability than BMI alone. These findings may help surgeons decide preoperatively whether a hand-sewn IPAA is feasible.
据报道，肥胖会增加溃疡性结肠炎（UC）患者进行回肠储袋肛管吻合术（IPAA）时技术上无法完成手术的风险。本研究旨在前瞻性调查内脏脂肪与手工缝合IPAA时储袋到达可行性之间的关联。
我们前瞻性纳入计划接受两阶段根治性直肠结肠切除术且术前计划进行手工缝合IPAA的UC患者。患者被分为术中需要转为吻合器IPAA的转换组和非转换组。术前使用计算机断层扫描（CT）测量内脏脂肪面积和解剖学指标。进行逻辑回归分析以确定转换手术的预测因素。
共纳入106例患者，其中转换组12例（11.3%）。与非转换组相比，转换组患者的体重指数（BMI）显著更高，内脏脂肪更多，回肠末端与肛门边缘之间的距离更长（p < 0.01）。逻辑回归分析确定内脏脂肪（每增加10 cm：比值比[OR] 1.19，95%置信区间[CI] 1.02 - 1.39，p = 0.01）是转换手术的显著预测因素，而BMI不是（OR 1.03，95% CI 0.77 - 1.21，p = 0.72）。
内脏脂肪是接受手工缝合IPAA患者进行转换手术的独立危险因素。基于术前CT测量内脏脂肪可能比单独使用BMI更准确地预测储袋可达性。这些发现可能有助于外科医生在术前决定手工缝合IPAA是否可行。
