Does preservation of the ileocecal valve make a difference? A propensity score matched comparison of Deloyers procedure versus extended right hemicolectomy.

Abstract

Background: When performing left hemicolectomies, surgeons might encounter difficulties when restoring bowel continuity. Ileocecal valve resection and performing an ileosigmoid anastomosis is one possible solution. An alternative is preserving the ileocecal valve by counterclockwise rotation of the remaining colon, ensuring a tension-free anastomosis. This study compares functional outcomes after Deloyers procedure and extended right colectomy with an ileosigmoid anastomosis.

Methods: Between 2008 and 2021, we included patients who underwent Deloyers procedure. Using propensity score matching, controls who underwent extended right hemicolectomy were identified. Perioperative outcomes were compared and patients were questioned using the St. Marks-score and the EORTC-29CR.

Results: We identified 19 patients who underwent the Deloyers procedure and 28 controls. Both groups had comparable mean age (61.4 years, p = 0.3), gender distribution (women: 40%, p = 0.19), ASA classification (p = 0.89) and BMI (26.8 kg/m², p = 74). Deloyers patients were less often treated for oncologic indications (53% vs. 86%, p = 0.02). Postoperative morbidity (37% vs. 36%, p = 0.99) and mortality (0 vs. 4%, p = 0.99) were similar. Deloyers patients reported worse body perception (83.3 vs. 100, p = 0.02), but frequency of bowel movements (2 vs. 3, p = 0.09) and use of antimotility agents (8% vs. 0%, p = 0.22) were comparable. The overall and individual results of the St. Marks and EORTC QLQ-CR29 questionnaires showed no significant differences (p > 0.05).

Conclusion: In our study, patients who underwent Deloyers procedure showed no mortality and comparable morbidity, functional and quality of life outcomes to patients who underwent extended right hemicolectomy.