Perioperative outcomes of ileorectal anastomosis - an analysis of 823 patients.
DLI
DVT
FAP
IBD
IRA
anastomotic leak
cancer
constipation
ileostomy
outcomes
postoperative complications
reoperation
syndrome
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
25 Mar 2024
25 Mar 2024
Historique:
revised:
21
01
2024
received:
10
07
2023
accepted:
24
02
2024
medline:
26
3
2024
pubmed:
26
3
2024
entrez:
25
3
2024
Statut:
aheadofprint
Résumé
Ileorectal anastomosis (IRA) following total abdominal colectomy (TAC) allows for resortation of bowel continuity but prior studies have reported rates of anastomotic leak (AL) to be as high as 23%. We aimed to report rates of AL and complications in a large cohort of patients undergoing IRA. We hypothesized that AL rates were lower than previously reported and that selective use of diverting loop ileostomy (DLI) is associated with decreased AL rates. Patients undergoing TAC or end-ileostomy reversal with IRA, with or without DLI, between 1980 and 2021 were identified from a prospectively maintained institutional database and retrospectively analysed. Redo IRA cases were excluded. Short-term (30-day) surgical outcomes were collected using our database. AL was defined using a combination of imaging and, in the case of return to the operating room, intraoperative findings. Of 823 patients in the study cohort, DLI was performed in 27% and performed more frequently for constipation and inflammatory bowel disease. The overall AL rate was 3% (1% and 4% in those with and without DLI, respectively) and diversion was found to be protective against leak (OR 0.28, 95% CI 0.08-0.94, p = 0.04). However, patients undergoing diversion had a higher overall rate of postoperative complications (51% vs. 36%, p < 0.001) including superficial wound infection, urinary tract infection, dehydration, blood transfusion and portomesenteric venous thrombosis (all p < 0.04). Our study represents the largest series of patients undergoing IRA reported to date and demonstrates an AL rate of 3%. While IRA appears to be a viable surgical option for diverse indications, our study underscores the importance of careful patient selection and thoughtful consideration of staging the anastomosis and temporary faecal diversion when necessary.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Association of Coloproctology of Great Britain and Ireland.
Références
Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg. 2007;245(2):254–258. https://doi.org/10.1097/01.sla.0000225083.27182.85
Burman JH, Cooke WT, Williams JA. The fate of ileorectal anastomosis in Crohn's disease. Gut. 1971;12(6):432–436. https://doi.org/10.1136/gut.12.6.432
Steinberg DM, Allan RN, Cooke WT, Alexander‐Williams J. The place of ileorectal anastomosis in Crohn's disease. Aust N Z J Surg. 1976;46(1):49–54. https://doi.org/10.1111/j.1445‐2197.1976.tb03193.x
Segelman J, Mattsson I, Jung B, Nilsson PJ, Palmer G, Buchli C. Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis. Colorectal Dis. 2018;20(4):304–311. https://doi.org/10.1111/codi.13938
O'Riordan JM, O'Connor BI, Huang H, Victor JC, Gryfe R, MacRae HM, et al. Long‐term outcome of colectomy and ileorectal anastomosis for Crohn's colitis. Dis Colon Rectum. 2011;54(11):1347–1354. https://doi.org/10.1097/DCR.0b013e31822c9b2d
Duclos J, Lefevre JH, Lefrançois M, Lupinacci R, Shields C, Chafai N, et al. Immediate outcome, long‐term function and quality of life after extended colectomy with ileorectal or ileosigmoid anastomosis. Colorectal Dis. 2014;16(8):O288–O296. https://doi.org/10.1111/codi.12558
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Lightner AL, Pemberton JH. The role of temporary fecal diversion. Clin Colon Rectal Surg. 2017;30(3):178–183. https://doi.org/10.1055/s‐0037‐1598158
Baelum JK, Qvist N, Ellebaek MB. Ileorectal anastomosis in patients with Crohn's disease. Postoperative complications and functional outcome‐a systematic review. Colorectal Dis. 2021;23(10):2501–2514. https://doi.org/10.1111/codi.15839
Nakamura T, Pikarsky AJ, Potenti FM, Lau CW, Weiss EG, Nogueras JJ, et al. Are complications of subtotal colectomy with ileorectal anastomosis related to the original disease? Am Surg. 2001;67(5):417–420.
Reshef A, Gurland B, Zutshi M, Kiran RP, Hull T. Colectomy with ileorectal anastomosis has a worse 30‐day outcome when performed for colonic inertia than for a neoplastic indication. Colorectal Dis. 2013;15(4):481–486. https://doi.org/10.1111/codi.12058
Elton C, Makin G, Hitos K, Cohen CR. Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg. 2003;90(1):59–65. https://doi.org/10.1002/bjs.4005
Rojas‐Machado SA, Romero‐Simó M, Arroyo A, Rojas‐Machado A, López J, Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta‐analysis of observational studies of risk factors. Int J Colorectal Dis. 2016;31(2):197–210. https://doi.org/10.1007/s00384‐015‐2422‐4
da Luz MA, Kiran RP, Lavery I. Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg. 2010;97(1):65–69. https://doi.org/10.1002/bjs.6809
Rojas‐Machado SA, Romero M, Arroyo A, Rojas‐Machado A, López J, Calpena R. Anastomic leak in colorectal cancer surgery. Development of a diagnostic index (DIACOLE). Int J Surg. 2016;27:92–98. https://doi.org/10.1016/j.ijsu.2016.01.089
Anele CC, Nachiappan S, Sinha A, Cuthill V, Jenkins JT, Clark SK, et al. Safety and efficacy of laparoscopic near‐total colectomy and ileo‐distal sigmoid anastomosis as a modification of total colectomy and ileorectal anastomosis for prophylactic surgery in patients with adenomatous polyposis syndromes: a comparative study. Colorectal Dis. 2020;22(7):799–805. https://doi.org/10.1111/codi.14964
Onder A, Benlice C, Church J, Kessler H, Gorgun E. Short‐term outcomes of laparoscopic versus open total colectomy with ileorectal anastomosis: a case‐matched analysis from a nationwide database. Tech Coloproctol. 2016;20(11):767–773. https://doi.org/10.1007/s10151‐016‐1539‐y