Evolution of laparoscopic ileal pouch-anal anastomosis: impact of enhanced recovery program, medication changes, and staged approaches on outcomes.

Autor: Violante T; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States; School of General Surgery, Alma Mater Studiorum - University of Bologna, Bologna, Italy., Ferrari D; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States; General Surgery Residency Program, University of Milan, Milan, Italy., Gomaa IA; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Rumer KK; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., D'Angelo AD; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Behm KT; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Shawki SF; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Perry WRG; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Kelley SR; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Mathis KL; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Dozois EJ; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Cima RR; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States., Larson DW; Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: Larson.David2@mayo.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Apr; Vol. 28 (4), pp. 501-506. Date of Electronic Publication: 2024 Jan 23.
DOI: 10.1016/j.gassur.2024.01.005
Abstrakt: Background: Although laparoscopic Ileal pouch-anal anastomosis (IPAA) has become the gold standard in restorative proctocolectomy, surgical techniques have experienced minimal changes. In contrast, substantial shifts in perioperative care, marked by the enhanced recovery program (ERP), modifications in steroid use, and a shift to a 3-staged approach, have taken center stage.
Methods: Data extracted from our prospective IPAA database focused on the first 100 laparoscopic IPAA cases (historic group) and the latest 100 cases (modern group), aiming to measure the effect of these evolutions on postoperative outcomes.
Results: The historic IPAA group had more 2-staged procedures (92% proctocolectomy), whereas the modern group had a higher number of 3-staged procedures (86% proctectomy) (P < .001). Compared with patients in the modern group, patients in the historic group were more likely to be on steroids (5% vs 67%, respectively; P < .001) or immunomodulators (0% vs 31%, respectively; P < .001) at surgery. Compared with the historic group, the modern group had a shorter operative time (335.5 ± 78.4 vs 233.8 ± 81.6, respectively; P < .001) and length of stay (LOS; 5.4 ± 3.1 vs 4.2 ± 1.6 days, respectively; P < .001). Compared with the modern group, the historic group exhibited a higher 30-day morbidity rate (20% vs 33%, respectively; P = .04) and an elevated 30-day readmission rate (9% vs 21%, respectively; P = .02). Preoperative steroids use increased complications (odds ratio [OR], 3.4; P = .01), whereas 3-staged IPAA reduced complications (OR, 0.3; P = .03). ERP was identified as a factor that predicted shorter stays.
Conclusion: Although ERP effectively reduced the LOS in IPAA surgery, it failed to reduce complications. Conversely, adopting a 3-staged IPAA approach proved beneficial in reducing morbidity, whereas preoperative steroid use increased complications.
(Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE