Long Rectal Cuff and Remnant Mesorectum Are Major Preventable Causes of Ileal Pouch Failure.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Mehmet Gulmez, Pranav Hinduja, Eren Esen, Michael J Grieco, Arman Erkan, Andre da Luz Moreira, John Kirat, Feza H Remzi
{"title":"Long Rectal Cuff and Remnant Mesorectum Are Major Preventable Causes of Ileal Pouch Failure.","authors":"Mehmet Gulmez, Pranav Hinduja, Eren Esen, Michael J Grieco, Arman Erkan, Andre da Luz Moreira, John Kirat, Feza H Remzi","doi":"10.1097/DCR.0000000000003530","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Long rectal cuff (>2 cm) and remnant mesorectum are known causes of pouch dysfunction due to obstructive defecation, as well as pelvic sepsis after prolonged obstruction.</p><p><strong>Objective: </strong>The aim of this study is to report the rates and the management of patients who underwent re-do ileal pouch anal anastomosis due to pouch failure associated with retained mesorectum and long rectal cuff.</p><p><strong>Design: </strong>This is a retrospective study.</p><p><strong>Settings: </strong>The investigation is based on a quaternary inflammatory bowel disease center.</p><p><strong>Patients: </strong>Patients undergoing re-do ileal pouch anal anastomosis surgery and had long rectal cuff and/or remnant mesorectum between September 2016 and September 2023 were included in the study.</p><p><strong>Main outcome measures: </strong>The main outcomes were functioning pouch rate and functional results.</p><p><strong>Results: </strong>Of the 245 patients who underwent re-do ileal pouch anal anastomosis surgery, 98 (40%) patients had long rectal cuff and/or remnant mesorectum. Re-do ileal pouch anal anastomosis in this patient group was successful (92%) at a median follow-up of 28 (18-52) months.</p><p><strong>Limitations: </strong>The retrospective nature of the study and this is the experience of a single specialized center.</p><p><strong>Conclusions: </strong>Long rectal cuff and remanent mesorectum are major causes of pouch failure which can be successfully managed with re-do ileal pouch anal anastomosis surgery. Nearly half of pouch failure patients who had successful re-do ileal pouch anal anastomosis surgery initially received unnecessary biologic therapy before coming to our center. See Video abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diseases of the Colon & Rectum","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/DCR.0000000000003530","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Long rectal cuff (>2 cm) and remnant mesorectum are known causes of pouch dysfunction due to obstructive defecation, as well as pelvic sepsis after prolonged obstruction.

Objective: The aim of this study is to report the rates and the management of patients who underwent re-do ileal pouch anal anastomosis due to pouch failure associated with retained mesorectum and long rectal cuff.

Design: This is a retrospective study.

Settings: The investigation is based on a quaternary inflammatory bowel disease center.

Patients: Patients undergoing re-do ileal pouch anal anastomosis surgery and had long rectal cuff and/or remnant mesorectum between September 2016 and September 2023 were included in the study.

Main outcome measures: The main outcomes were functioning pouch rate and functional results.

Results: Of the 245 patients who underwent re-do ileal pouch anal anastomosis surgery, 98 (40%) patients had long rectal cuff and/or remnant mesorectum. Re-do ileal pouch anal anastomosis in this patient group was successful (92%) at a median follow-up of 28 (18-52) months.

Limitations: The retrospective nature of the study and this is the experience of a single specialized center.

Conclusions: Long rectal cuff and remanent mesorectum are major causes of pouch failure which can be successfully managed with re-do ileal pouch anal anastomosis surgery. Nearly half of pouch failure patients who had successful re-do ileal pouch anal anastomosis surgery initially received unnecessary biologic therapy before coming to our center. See Video abstract.

长直肠袖带和残余中直肠是回肠袋失败的主要可预防原因。
背景:长直肠套管(>2 厘米)和残余直肠系膜是导致排便受阻造成肛袋功能障碍以及长期梗阻后发生盆腔败血症的已知原因:本研究旨在报告因直肠中膜残留和直肠长袖带导致肛门吻合术失败而接受回肠袋肛门吻合术的患者的比例和处理方法:这是一项回顾性研究:调查基于一个四级炎症性肠病中心:研究对象:2016年9月至2023年9月期间接受回肠袋肛门吻合术再手术且有长直肠袖带和/或残余直肠中膜的患者:主要结果为功能袋率和功能结果:在接受回肠袋肛门吻合术的245例患者中,98例(40%)患者有长直肠袖带和/或残余直肠系膜。在中位随访28(18-52)个月时,这组患者中再做回肠袋肛门吻合术的成功率为92%:局限性:本研究为回顾性研究,且仅为一家专科中心的经验:结论:长直肠袖带和残留的直肠系膜是导致肠袋失败的主要原因,通过重新进行回肠肠袋肛门吻合手术可以成功解决这一问题。在成功接受回肠袋肛门吻合术的失败患者中,有近一半的患者在来本中心之前接受了不必要的生物治疗。查看视频摘要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信