Diseases of the colon and rectum · 2015
Restorative proctocolectomy with a handsewn IPAA: S-pouch or J-pouch?
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Wu Xian-Rui, Kirat Hasan T, Kalady Matthew F, Church James M
Аннотация
BACKGROUND: The efferent limb on the S-pouch fits well into the anal canal while the body of the pouch lies on the levators. In contrast, the blunt end of a J-pouch may be distorted as it is forced into the muscular tube of the stripped anus.
OBJECTIVE: The aim of this study is to compare the clinical outcomes and quality of life between patients with S- and J-pouches with a handsewn IPAA.
DESIGN: This study was retrospective.
SETTING: This study was conducted at a high-volume tertiary referral center.
PATIENTS: Patients undergoing a primary handsewn IPAA from 1983 to 2012 were identified.
MAIN OUTCOMES MEASURES: Demographics, operative details, functional outcomes, and quality of life were abstracted.
RESULTS: A total of 502 patients, including 169 patients with an S-pouch (33.7%) and 333 patients with J-pouch (66.3%), met our inclusion criteria; 55.8% (n = 280) were men. Mean age at pouch construction was 37.8 ± 12.5 years. Patients with an S-pouch were younger (p = 0.004) and had a higher BMI (p = 0.035) at pouch surgery. There was no significant difference between patients with S- or J-pouches in other demographics. The frequencies of short-term complications in the 2 groups were similar (p > 0.05), but pouch fistula or sinus (p = 0.047), pelvic sepsis (p = 0.044), postoperative partial small-bowel obstruction (p = 0.003), or postoperative pouch-related hospitalization (p = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3-20.1) years, patients with an S-pouch were found to have fewer bowel movements (p < 0.001), less frequent pad use (p = 0.001), and a lower fecal incontinence severity index score (p = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration.
LIMITATIONS: The use of data from a single tertiary referral center was a limitation of this study.
CONCLUSION: We recommend using an S-pouch when constructing an IPAA with a handsewn technique.
OBJECTIVE: The aim of this study is to compare the clinical outcomes and quality of life between patients with S- and J-pouches with a handsewn IPAA.
DESIGN: This study was retrospective.
SETTING: This study was conducted at a high-volume tertiary referral center.
PATIENTS: Patients undergoing a primary handsewn IPAA from 1983 to 2012 were identified.
MAIN OUTCOMES MEASURES: Demographics, operative details, functional outcomes, and quality of life were abstracted.
RESULTS: A total of 502 patients, including 169 patients with an S-pouch (33.7%) and 333 patients with J-pouch (66.3%), met our inclusion criteria; 55.8% (n = 280) were men. Mean age at pouch construction was 37.8 ± 12.5 years. Patients with an S-pouch were younger (p = 0.004) and had a higher BMI (p = 0.035) at pouch surgery. There was no significant difference between patients with S- or J-pouches in other demographics. The frequencies of short-term complications in the 2 groups were similar (p > 0.05), but pouch fistula or sinus (p = 0.047), pelvic sepsis (p = 0.044), postoperative partial small-bowel obstruction (p = 0.003), or postoperative pouch-related hospitalization (p = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3-20.1) years, patients with an S-pouch were found to have fewer bowel movements (p < 0.001), less frequent pad use (p = 0.001), and a lower fecal incontinence severity index score (p = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration.
LIMITATIONS: The use of data from a single tertiary referral center was a limitation of this study.
CONCLUSION: We recommend using an S-pouch when constructing an IPAA with a handsewn technique.