Defunctioning Ileostomy is not Associated with Reduced Leakage in Proctocolectomy and Ileal Pouch Anastomosis Surgeries for IBD.

Autor: Sahami S; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., Buskens CJ; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., Fadok TY; Department of Surgery, Mayo Clinic College of Medicine, Phoenix, AZ, USA., Tanis PJ; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., de Buck van Overstraeten A; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium., Wolthuis AM; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium., Bemelman WA; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands w.a.bemelman@amc.uva.nl., D'Hoore A; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
Jazyk: angličtina
Zdroj: Journal of Crohn's & colitis [J Crohns Colitis] 2016 Jul; Vol. 10 (7), pp. 779-85. Date of Electronic Publication: 2015 Oct 28.
DOI: 10.1093/ecco-jcc/jjv201
Abstrakt: Background: Anastomotic leakage is a serious complication after restorative proctocolectomy with ileal pouch-anal anastomosis. Previous studies have shown significantly decreased leak rates in diverted patients with less severe clinical consequences. The aim of this study was to evaluate short- and long-term outcome of selective ileostomy formation in a multicentre cohort of patients undergoing pouch surgery.
Methods: In a retrospective study, 621 patients undergoing pouch surgery for inflammatory bowel disease [IBD] were identified from three large centres. Anastomotic leakage was defined as any leak confirmed by either contrast extravasation on imaging or during surgical re-intervention.
Results: In 305 patients [49.1%], primary defunctioning ileostomy was created during pouch surgery and 41 [6.6%] patients received a secondary ileostomy because of a leaking non-diverted pouch. Primary ileostomy formation was associated with male sex, weight loss, American Society of Anesthesiologists score [ASA] > 2, steroid use, one-stage surgery, hand-sewn anastomosis, and blood transfusion. Leak rates were comparable between diverted and non-diverted patients [16.7% vs 17.1%, p = 0.92], which remained unchanged in subgroups with immunosuppressive medication. Having had an ileostomy was demonstrated to be an independent predictor of small bowel obstruction (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.45 - 4.67) and pouch fistulas [OR 3.05, 95%CI 1.06 - 8.73]. The 10-year pouch survival was comparable for patients with and without ileostomy [89% versus 88%, p = 0.718].
Conclusions: Leakage rates of diverted and non-diverted pouches in IBD patients were similar and relatively high. Defunctioning was independently associated with long-term complications. A staged approach without defunctioning might be the best strategy.
(Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE
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