Abstract：
OBJECTIVE: The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis.
METHODS: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.
RESULTS: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.
CONCLUSIONS: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.
METHODS: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.
RESULTS: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.
CONCLUSIONS: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.
摘要：
目的：这项工作的目的是研究左结肠憩室炎患者术后早期吻合口漏或盆腔脓肿（AL/PA）与症状性吻合口狭窄（SAS）之间的关系。
方法：这是一项由FrançaisedeChirurgie协会进行的全国性憩室炎手术患者队列研究的回顾性研究。使用路径分析进行评估。该数据库包括7053名接受结肠憩室炎手术的患者，选择性或在紧急情况下进行手术，通过开放式或腹腔镜检查。从研究分析中排除存在（i）右侧憩室炎的患者（初始数据库包括所有连续接受结肠憩室炎手术的患者），（ii）在第一次手术期间未进行吻合或（iii）缺少有关狭窄的信息，术后脓肿或吻合口漏。
结果：在纳入最终分析的4441例患者中，327例（4.6%）发生AL/PA，82例（1.8%）发生SAS。AL/PA是与SAS发生风险相关的独立因素（OR=3.41，95％CI=1.75-6.66）。与分流造口≥100天的情况一样(OR=2.77，95%CI=1.32-5.82)，而肠系膜下动脉近端中心血管结扎与风险降低相关(OR=0.41;95%CI=0.19~0.88).造口分流<100天或≥100天也是与AL/PA风险相关的因素(OR=3.08,95%CI=2-4.75,OR=12.95,95%CI=9.11-18.50)。有趣的是,AL/PA和SAS的放射引流或手术治疗之间没有显著关联.
结论：AL/PA是与SAS风险相关的独立因素。AL/PA的治疗与吻合口狭窄的发生无关。分流造口与AL/PA和SAS的风险增加相关。特别是如果它被放置≥100天。医生必须了解这些信息，以便在择期或紧急手术期间创建造口时决定最佳行动方案。
方法：这是一项由FrançaisedeChirurgie协会进行的全国性憩室炎手术患者队列研究的回顾性研究。使用路径分析进行评估。该数据库包括7053名接受结肠憩室炎手术的患者，选择性或在紧急情况下进行手术，通过开放式或腹腔镜检查。从研究分析中排除存在（i）右侧憩室炎的患者（初始数据库包括所有连续接受结肠憩室炎手术的患者），（ii）在第一次手术期间未进行吻合或（iii）缺少有关狭窄的信息，术后脓肿或吻合口漏。
结果：在纳入最终分析的4441例患者中，327例（4.6%）发生AL/PA，82例（1.8%）发生SAS。AL/PA是与SAS发生风险相关的独立因素（OR=3.41，95％CI=1.75-6.66）。与分流造口≥100天的情况一样(OR=2.77，95%CI=1.32-5.82)，而肠系膜下动脉近端中心血管结扎与风险降低相关(OR=0.41;95%CI=0.19~0.88).造口分流<100天或≥100天也是与AL/PA风险相关的因素(OR=3.08,95%CI=2-4.75,OR=12.95,95%CI=9.11-18.50)。有趣的是,AL/PA和SAS的放射引流或手术治疗之间没有显著关联.
结论：AL/PA是与SAS风险相关的独立因素。AL/PA的治疗与吻合口狭窄的发生无关。分流造口与AL/PA和SAS的风险增加相关。特别是如果它被放置≥100天。医生必须了解这些信息，以便在择期或紧急手术期间创建造口时决定最佳行动方案。
