Complications and failure after Kock continent ileostomy: A systematic review and meta-analysis.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2024-10-01 DOI:10.1007/s10151-024-03018-x

S H Emile, Z Garoufalia, S Mavrantonis, P Rogers, S H Barsom, N Horesh, R Gefen, S D Wexner

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引用次数: 0

Abstract

Background: A significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP.

Methods: This Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review (CRD42023416961) searched PubMed, Scopus, and Web of Science for studies on adult patients with Kock continent ileostomy published after the year 2000. The main outcome measures were revision, complications, and failure of the KP. Risk factors for complications and failure were assessed using a meta-regression analysis. Risk of bias was assessed using the ROBINS-1 tool. A proportional meta-analysis of the main outcomes was performed.

Results: A total of 19 studies (2042 patients) were included. The weighted mean prevalence of complications was 60.4% [95% confidence interval (CI): 46.1-74.7%], of pouch revision was 46.6% (95% CI: 38.5-54.7%), and of pouch failure was 12.9% (95% CI: 9.3-16.4%). Studies conducted in the USA had a mean failure prevalence of 12.6% (95% CI: 6.2-18.9%) comparable to studies conducted in Europe (11.1%; 95% CI: 7.5-14.7%). Factors associated with higher complications were increased body mass index (BMI) and previous ileoanal pouch anastomosis (IPAA); however, these factors were not associated with increased pouch failure.

Conclusions: The KP is a highly complex operation as shown by a pooled complication prevalence of 60%, and thus, it should be only performed by experienced surgeons. Despite the high prevalence of complications and need for revisional surgery, patients are keen to preserve their KP. Increased BMI and a previous failed IPAA are risk factors for pouch complications, but not failure.

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科克大陆性回肠造口术后的并发症和失败：系统回顾和荟萃分析。

背景：大量患者因Kock胃袋（KP）并发症而需要进行翻修或切除。本系统综述旨在评估 KP 并发症和失败的总体发生率和风险因素：这项符合系统综述和荟萃分析（PRISMA）首选报告项目（CRD42023416961）的系统综述检索了 PubMed、Scopus 和 Web of Science 上 2000 年以后发表的有关 Kock 造口术成年患者的研究。主要结果指标为 KP 的翻修、并发症和失败。并发症和失败的风险因素采用元回归分析法进行评估。偏倚风险采用 ROBINS-1 工具进行评估。对主要结果进行了比例荟萃分析：共纳入 19 项研究（2042 名患者）。并发症的加权平均发生率为 60.4% [95% 置信区间 (CI)：46.1-74.7%]，肠袋翻修率为 46.6% (95% CI：38.5-54.7%)，肠袋失败率为 12.9% (95% CI：9.3-16.4%)。在美国进行的研究中，失败率平均为 12.6%（95% CI：6.2-18.9%），与欧洲的研究（11.1%；95% CI：7.5-14.7%）相当。体质指数（BMI）升高和曾进行过回肠肛门袋吻合术（IPAA）是并发症增加的相关因素，但这些因素与肛门袋失败率增加无关：KP是一项非常复杂的手术，其并发症发生率高达60%，因此只有经验丰富的外科医生才能进行KP手术。尽管并发症发生率高且需要进行翻修手术，但患者仍热衷于保留 KP。体重指数（BMI）升高和之前的IPAA手术失败是导致胃袋并发症的风险因素，但不是手术失败的风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.