Surgical endoscopy · 2024
A review of early small bowel obstructions in staged IPAA procedures.
СтатьяНазвание и аннотация: Перевод в очереди
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Coste Marine, Cao Sarah, Kayal Maia, Wang Yun Hwa Walter, Hahn Sue J, Khaitov Sergey, Sylla Patricia A, Dubinsky Marla C, Plietz Michael C, Greenstein Alexander J
Аннотация
BACKGROUND: Small bowel obstructions (SBOs) are a common complication following staged IPAA. Our goal was to compare early post-operative SBO outcomes between different staged ileal pouch-anal anastomosis (IPAA) and to further analyze the type of procedures required in patients who needed operative management of SBO.
METHODS: In this retrospective cohort study, we selected all patients who presented to our tertiary care center between 2008 and 2017, with ulcerative colitis or IBD-Unspecified colitis and who underwent a primary total proctocolectomy with IPAA for medically refractory disease or dysplasia (n = 623). Patients were divided into 4 groups based on staged IPAA received (1 stage vs 2 stage vs modified 2 stage vs 3 stage). Primary outcomes were compared between both groups using univariate analysis and included SBO within 6 months post-operatively of one of the IPAA stages or 18 months since the first surgery for patients who underwent 1 or 2 stage IPAAs, and need for readmission and reoperation. Risk factors for SBO, reoperation and readmission due to SBO were evaluated using multivariate logistic regression.
RESULTS: Stage 2 and 3 patients had the highest rates of SBO post-operatively. There was a significant difference in the rate of readmission between groups, with 2 and 3 stage groups having the highest rates (p < 0.05) but the rate of SBO and reoperations was not significantly different between groups. Of all patients with an SBO, 34% required operative intervention. Of these, 65% underwent diagnostic laparoscopy with lysis of adhesions and 27% required an open procedure.
CONCLUSION: Small bowel obstructions are a common complication of staged IPAA procedures. Patients who underwent 2 and 3 stage IPAA had the highest rates of SBO, although not statistically significant. A third of patients with an SBO required surgical intervention, with diagnostic laparoscopy and lysis of adhesions being the most common procedure.
METHODS: In this retrospective cohort study, we selected all patients who presented to our tertiary care center between 2008 and 2017, with ulcerative colitis or IBD-Unspecified colitis and who underwent a primary total proctocolectomy with IPAA for medically refractory disease or dysplasia (n = 623). Patients were divided into 4 groups based on staged IPAA received (1 stage vs 2 stage vs modified 2 stage vs 3 stage). Primary outcomes were compared between both groups using univariate analysis and included SBO within 6 months post-operatively of one of the IPAA stages or 18 months since the first surgery for patients who underwent 1 or 2 stage IPAAs, and need for readmission and reoperation. Risk factors for SBO, reoperation and readmission due to SBO were evaluated using multivariate logistic regression.
RESULTS: Stage 2 and 3 patients had the highest rates of SBO post-operatively. There was a significant difference in the rate of readmission between groups, with 2 and 3 stage groups having the highest rates (p < 0.05) but the rate of SBO and reoperations was not significantly different between groups. Of all patients with an SBO, 34% required operative intervention. Of these, 65% underwent diagnostic laparoscopy with lysis of adhesions and 27% required an open procedure.
CONCLUSION: Small bowel obstructions are a common complication of staged IPAA procedures. Patients who underwent 2 and 3 stage IPAA had the highest rates of SBO, although not statistically significant. A third of patients with an SBO required surgical intervention, with diagnostic laparoscopy and lysis of adhesions being the most common procedure.