IMMEDIATE AND LATE RESULTS OF ILEOSTOMY CLOSURE IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS UNDERGOING RESTORATIVE PROCTOCOLECTOMY BY OPEN OR LAPAROSCOPIC APPROACHES.
Fábio Guilherme Campos, Carlos Augusto Real Martinez, Carlos Frederico Sparapan Marques, Ulysses Ribeiro Junior, Paulo Herman
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引用次数: 0
Abstract
Background: Restorative proctocolectomy (RPC) is a common surgical indication to manage familial adenomatous polyposis (FAP) patients.
Objective: We compared outcomes after ileostomy closure in patients undergoing laparoscopic (LAP) or conventional (OPEN) RPC at one single institution.
Methods: Charts from FAP patients (1997-2013) were reviewed. Demographic data (age, sex, previous surgery) and surgical outcomes (original surgical approach, early and late morbidity, complications and reoperations after ileostomy closure) were compared.
Results: A total of 84 patients (53 women and 31 men) submitted to ileostomy closure at a mean age of 30.6 years (11-64) were analyzed. Twenty-one (25%) and 63 patients (75%) formed the OPEN and LAP groups, respectively. Demographic features were similar. After pouch construction, 27 early (32.1%) and 8 late (9.5%) complications occurred, with no mortality. Although overall morbidity rates were similar between both approaches, late complications rate were less common in LAP patients (7.9% x 14.2%). After ileostomy closure, complications were registered in 6 (7.1%) patients, and patients previously operated with the LAP approach also presented less complications (4.7% x 14.2%) and reoperations (3.1% x 9.5%). Additionally, the need for surgical management of complications was greater in the OPEN (9.5%) than the LAP group (3.1%). Besides these numbers, analysis didn't reveal statistical differences among both groups.
Conclusion: In the conditions of the present manuscript, the abdominal approach used for restorative proctocolectomy doesn't seem to decisively influence outcomes after loop ileostomy reversal. In the future, analysis of a greater number of patients may probably demonstrate an expected greater complication and reoperation rates in those previously treated through OPEN procedures.
Background: • Ileostomy closure is an important part of the surgical treatment of FAP patients undergoing restorative proctocolectomy by any approach.
Background: • Complication rates after loop ileostomy reversal occurred in 7% of a group of 84 FAP patients.
Background: • Among those operated with the laparoscopic approach, complications (4.7% x 14.2%) an reoperations (3.15% X .5%) were less common when compared to the group treated with conventional approach.
Background: • In the future, annalysis of a greater number of patients may probably reveal an statistical difference between these numbers, thus clearly demonstrating this great advantage of minimally invasive procedures in this group of patients.
背景：恢复性直结肠切除术（RPC）是治疗家族性腺瘤性息肉病（FAP）患者的常见手术指征。目的：我们比较了在同一机构接受腹腔镜（LAP）或常规（OPEN） RPC的患者在回肠造口关闭后的结果。方法：回顾1997-2013年FAP患者的病历。比较人口统计学资料（年龄、性别、既往手术）和手术结果（原始手术入路、早期和晚期发病率、并发症和回肠造口术后再手术）。结果：本组共84例患者（女性53例，男性31例）行回肠造口术，平均年龄30.6岁（11-64岁）。OPEN组21例（25%），LAP组63例（75%）。人口统计学特征相似。术后早期并发症27例（32.1%），晚期并发症8例（9.5%），无死亡。虽然两种方法的总发病率相似，但LAP患者的晚期并发症发生率较低（7.9% x 14.2%）。回肠造口闭合后，6例（7.1%）患者出现并发症，先前采用LAP入路的患者并发症（4.7% x 14.2%）和再手术（3.1% x 9.5%）也较少。此外，OPEN组对并发症的手术治疗需求（9.5%）高于LAP组（3.1%）。除了这些数字，分析并没有揭示两组之间的统计差异。结论：在本文的条件下，采用腹部入路进行恢复性直结肠切除术似乎对回肠袢造口逆转后的预后没有决定性影响。在未来，对更多患者的分析可能会显示出先前通过OPEN手术治疗的患者预期的更高的并发症和再手术率。背景：•回肠造口闭合是任何入路行恢复性直结肠切除术的FAP患者手术治疗的重要组成部分。背景：84例FAP患者中，7%的患者在回肠袢造口术逆转后出现并发症。背景：•与常规入路组相比，腹腔镜入路组并发症（4.7% x 14.2%）和再手术（3.15% x 0.5%）发生率较低。背景：•未来，对更多患者的分析可能会揭示这些数字之间的统计学差异，从而清楚地证明微创手术在这组患者中的巨大优势。
期刊介绍：
The journal Arquivos de Gastroenterologia (Archives of Gastroenterology), a quarterly journal, is the Official Publication of the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia IBEPEGE (Brazilian Institute for Studies and Research in Gastroenterology), Colégio Brasileiro de Cirurgia Digestiva - CBCD (Brazilian College of Digestive Surgery) and of the Sociedade Brasileira de Motilidade Digestiva - SBMD (Brazilian Digestive Motility Society). It is dedicated to the publishing of scientific papers by national and foreign researchers who are in agreement with the aim of the journal as well as with its editorial policies.
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