Split stoma with delayed anastomosis may be preferred for 2-stage surgical resection in high-risk patients with Crohn's disease
| Autor: | Xiaowen He, Senmao Li, Jiancong Hu, Yongle Chen, Jia Ke, Z.-q. Zhang, Lei Lian, Ping Lan, Jian Tang, Xiaojian Wu, Zheyu Zheng |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Anastomosis Tertiary referral hospital digestive system Stoma Postoperative Complications Crohn Disease medicine Humans Stage (cooking) Adverse effect Digestive System Surgical Procedures Retrospective Studies Crohn's disease High risk patients business.industry Anastomosis Surgical Surgical Stomas Bowel resection medicine.disease digestive system diseases Surgery surgical procedures operative business |
| Zdroj: | Surgery. 171(6) |
| ISSN: | 1532-7361 |
| Popis: | Fecal diversion after bowel resection is a safe and effective procedure in high-risk patients with Crohn's disease, but the better approach between primary anastomosis with protective stoma and split stoma with delayed anastomosis has not yet been investigated. This study aimed to compare the outcomes of these approaches in high-risk patients with Crohn's disease.A retrospective investigation on consecutive high-risk patients with Crohn's disease was conducted at a tertiary referral hospital from August 2009 to March 2019. The primary outcomes were the overall early postoperative complications and overall anastomosis-related adverse events in an intention-to-treat approach.A total of 118 consecutive patients who underwent 121 surgeries (35 procedures with a protective stoma and 86 procedures with a split stoma) were enrolled. After a median follow-up period of 659 days and 728 days, respectively, 25 patients underwent a stoma-reversal procedure in the protective-stoma group, and 54 patients underwent delayed anastomosis in the split stoma group. Overall, early 30-day surgical morbidity and anastomosis-related adverse events were observed in more patients in the protective-stoma group than in the split-stoma group (51.4% [18/35] vs 30.2% [26/86]; P = .028 and 37.1% [13/35] vs 2.3% [2/86]; P.001, respectively; intention-to-treat analysis). Similar results were found in the per-protocol analysis (44.0% [11/25] vs 20.4% [11/54]; P = .029 and 36.0% [12/25] vs 3.7% [2/54]; P.001, respectively.) CONCLUSION: Split stoma with delayed anastomosis is associated with a reduction in anastomotic adverse events and overall early surgical complications and thus may be a better surgical option for high-risk patients with Crohn's disease. |
| Databáze: | OpenAIRE |
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