背景:回肠袋-肛门吻合术是一项技术要求高的手术,有许多潜在的并发症。回肠造口术的改道通常是小袋抢救的第一步;然而,尚不清楚个别患者是否会接受随后的袋抢救手术。我们的目的是在我们的邮袋注册表中描述逆转的适应症以及短期和长期结果。
方法:我们查询了1985年至2022年在我们机构接受2-或3-阶段IPAA指数和随后重新转换的患者的机构邮袋注册。其他地方建造的小袋,重新转换到其他地方,或那些接受了囊袋抢救/切除而没有先前重新逆转的患者被排除在外.根据外科医生的判断选择患者进行袋抢救。
结果:总体而言,177例患者(5207个索引袋的3.4%)被重新恢复。在索引袋处,中位患者年龄为32岁,50.8%为女性.诊断包括溃疡性结肠炎(86.4%),不确定性结肠炎(6.2%),家族性腺瘤性息肉病(4.0%),和其他(3.4%)。从先前的回肠造口术关闭到重新逆转的中位时间为7.2年。98例(55.4%)患者的回复性适应症为炎性,79例(44.6%)患者为非炎性。重新反转后,52%的人接受了小袋抢救,30%的人没有进一步的手术,18.1%接受了囊袋切除术。炎症和非炎症指征的5年囊袋生存率分别为71.5%和94.5%,分别(P=0.02)。
结论:回肠袋的改道是管理失效袋的安全初始策略,并且是许多患者进行袋抢救的有用的第一步。随后的针对非炎性适应症的抢救手术的抢救率明显高于针对炎性并发症的抢救手术。
回肠造口术是安全的,有用的袋袋打捞的第一步,随后针对非炎性适应症的抢救手术的囊袋抢救率明显高于针对炎性并发症的抢救手术.
BACKGROUND: Ileal pouch-anal anastomosis is a technically demanding procedure with many potential complications. Rediversion with an ileostomy is often the first step in pouch salvage; however, it may not be clear if an individual patient will undergo subsequent pouch salvage surgery. We aimed to describe the indications and short- and long-term outcomes of rediversion in our pouch registry.
METHODS: We queried our institutional pouch registry for patients who underwent index 2- or 3-stage IPAA and subsequent rediversion at our institution between 1985 and 2022. Pouches constructed elsewhere, rediverted elsewhere, or those patients who underwent pouch salvage/excision without prior rediversion were excluded. Patients were selected for pouch salvage according to the surgeon\'s discretion.
RESULTS: Overall, 177 patients (3.4% of 5207 index pouches) were rediverted. At index pouch, median patient age was 32 years and 50.8% were women. Diagnoses included ulcerative colitis (86.4%), indeterminate colitis (6.2%), familial adenomatous polyposis (4.0%), and others (3.4%). Median time from prior ileostomy closure to rediversion was 7.2 years. Indications for rediversion were inflammatory in 98 (55.4%) and noninflammatory in 79 (44.6%) patients. After rediversion, 52% underwent pouch salvage, 30% had no further surgery, and 18.1% underwent pouch excision. The 5-year pouch survival rates for inflammatory and noninflammatory indications were 71.5% and 94.5%, respectively (P = .02).
CONCLUSIONS: Rediversion of ileoanal pouches is a safe initial strategy to manage failing pouches and is a useful first step in pouch salvage in many patients. Subsequent salvage surgery for noninflammatory indications had a significantly higher pouch salvage rate than those rediverted for inflammatory complications.
Rediversion with an ileostomy was a safe, useful first step in pouch salvage, and subsequent salvage surgery for noninflammatory indications had a significantly higher pouch salvage rate than those rediverted for inflammatory complications.