Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Restoring bowel continuity after extended left colectomy: a comparative study of the retroileal window and Deloyers techniques.
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Schabl Lukas, Sobrado Lucas F, Khan Imran, Erozkan Kamil, Jäger Tarkan, Steele Scott R, Hull Tracy L
Аннотация
BACKGROUND: Establishing an anastomosis after an extended left hemicolectomy can be challenging due to insufficient colonic reach. Surgical options include the Deloyers technique (DT) and the retroileal window technique (RIWT). The primary objective was to compare the safety and functional outcomes of these restorative techniques.
METHODS: This retrospective cohort analysis used prospectively collected data on postoperative quality of life (QoL) and bowel function. Adult patients who underwent either RIWT or DT at a tertiary center between 1995 and 2023 were included in the study. The primary outcomes were complications, patient-reported bowel function, and QoL, which were assessed using validated questionnaires.
RESULTS: RIWT was performed in 87 patients, and DT was performed in 97 patients. Cancer was the most common indication in both groups. RIWT occurred more during index operation (64.4% in the RIWT group vs 33.0% in the DT group; P <.001), whereas DT had higher rates of low anastomosis (57.7% in the DT group vs 27.6% in the RIWT group; P <.001) and protective stomas (69.1% in the DT group vs 19.5% in the RIWT group; P <.001). RIWT had higher odds of postoperative ileus (odds ratio, 7.2 [95% CI, 1.7-30.2]; P =.007). Other postoperative complications, including Clavien-Dindo grade > II events, were comparable. DT showed more dietary and social restrictions and bowel movements at night and per 24 h on univariate analysis, although not significant on multivariate analysis. The Wexner continence scores and QoL were similar between the groups.
CONCLUSION: RIWT and DT are safe and effective techniques for achieving tension-free anastomosis after extended left colectomy. Given the comparable complication rates and functional outcomes, the choice of surgical technique should be based on intraoperative findings and surgeon expertise.
METHODS: This retrospective cohort analysis used prospectively collected data on postoperative quality of life (QoL) and bowel function. Adult patients who underwent either RIWT or DT at a tertiary center between 1995 and 2023 were included in the study. The primary outcomes were complications, patient-reported bowel function, and QoL, which were assessed using validated questionnaires.
RESULTS: RIWT was performed in 87 patients, and DT was performed in 97 patients. Cancer was the most common indication in both groups. RIWT occurred more during index operation (64.4% in the RIWT group vs 33.0% in the DT group; P <.001), whereas DT had higher rates of low anastomosis (57.7% in the DT group vs 27.6% in the RIWT group; P <.001) and protective stomas (69.1% in the DT group vs 19.5% in the RIWT group; P <.001). RIWT had higher odds of postoperative ileus (odds ratio, 7.2 [95% CI, 1.7-30.2]; P =.007). Other postoperative complications, including Clavien-Dindo grade > II events, were comparable. DT showed more dietary and social restrictions and bowel movements at night and per 24 h on univariate analysis, although not significant on multivariate analysis. The Wexner continence scores and QoL were similar between the groups.
CONCLUSION: RIWT and DT are safe and effective techniques for achieving tension-free anastomosis after extended left colectomy. Given the comparable complication rates and functional outcomes, the choice of surgical technique should be based on intraoperative findings and surgeon expertise.