Is ileostomy mandatory for ileal pouch-anal anastomosis? A propensity matched analysis of 388 procedures.
Surgery
; 168(1): 113-118, 2020 07.
Article
in En
| MEDLINE
| ID: mdl-32299627
ABSTRACT
BACKGROUND:
Restorative proctocolectomy with ileal-pouch-anal anastomosis is the standard treatment for patients with ulcerative colitis or familial adenomatous polyposis. This procedure has undergone many changes and varies in 1, 2, or 3 stages. A diverting ileostomy can be created with the aim of reducing the consequence of an anastomotic leakage; however, its use is still unknown.METHOD:
The value of defunctioning ileostomy was studied in a population of 388 patients undergoing restorative proctocolectomy with ileal-pouch-anal anastomosis between 2005 and 2017. Leakage rate and postoperative morbidity were assessed. Patients were matched on a propensity score using the following criteria American Society of Anesthesiologists score, body mass index, diagnosis, surgical approach, and year.RESULTS:
Two hundred and three ileal-pouch-anal anastomosis for ulcerative colitis and 185 for familial adenomatous polyposis were performed representing 165 1-stage (61.6%), 79 classic 2-stage, 74 modified 2-stage, and 70 3-stage procedures. Regardless of the surgical strategy adopted, there were no significant differences in postoperative morbidity (P = .416), leakage rate (P = .369), and reoperation (P = .237), whether a diverting ileostomy was performed or not. After propensity score matching, there was no significant difference in postoperative morbidity (P = .363), leakage rate (P = .247), or reoperation (P = .243). The rate of persistent ileostomy at 1 year was higher in cases of classic 2-stage or 3-stage procedures (P = .036).CONCLUSION:
After propensity score matching, defunctioning ileostomy for ileal-pouch-anal anastomosis does not reduce leakage rate or postoperative morbidity, independent of the surgical strategy. Systematic ileostomy for ileal-pouch-anal anastomosis is probably not justified, and its place should be redefined in a randomized trial.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ileostomy
/
Proctocolectomy, Restorative
/
Anastomotic Leak
Type of study:
Clinical_trials
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Surgery
Year:
2020
Type:
Article
Affiliation country:
France