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Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis
BACKGROUND: Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal‐pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed t...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889852/ https://www.ncbi.nlm.nih.gov/pubmed/35261950 http://dx.doi.org/10.1002/ags3.12512 |
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author | Mori, Ryota Ogino, Takayuki Sekido, Yuki Hata, Tsuyoshi Takahashi, Hidekazu Miyoshi, Norikatsu Uemura, Mamoru Doki, Yuichiro Eguchi, Hidetoshi Mizushima, Tsunekazu |
author_facet | Mori, Ryota Ogino, Takayuki Sekido, Yuki Hata, Tsuyoshi Takahashi, Hidekazu Miyoshi, Norikatsu Uemura, Mamoru Doki, Yuichiro Eguchi, Hidetoshi Mizushima, Tsunekazu |
author_sort | Mori, Ryota |
collection | PubMed |
description | BACKGROUND: Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal‐pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed to clarify the risk factors for SOO after IPAA, focusing on the anatomical perspective. METHODS: This study included 68 UC patients who underwent IPAA with diverting ileostomy. These cases were analyzed based on clinicopathological factors and computed tomography (CT)‐based anatomical factors. RESULTS: SOO was identified in 18 patients (26.5%). We compared this SOO group with the non‐SOO group. The two groups significantly differed in sex distribution, and patients in the SOO group tended to have a longer postoperative hospital stay. Regarding surgery‐related factors, patients who underwent two‐stage surgery and experienced high‐output syndrome tended to develop SOO. Analysis of anatomical risk factors revealed that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA‐bEAS). This tendency remained significant even with adjustment for patient height. In multivariate analyses, adjusted rSMA‐bEAS (>191.0 mm/m) and male sex were independent risk factors associated with SOO. CONCLUSION: A long rSMA‐bEAS distance suggests that the mesentery is likely to be under tension. In such cases, surgeons should endeavor to avoid tension in the mesentery as much as possible. |
format | Online Article Text |
id | pubmed-8889852 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88898522022-03-07 Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis Mori, Ryota Ogino, Takayuki Sekido, Yuki Hata, Tsuyoshi Takahashi, Hidekazu Miyoshi, Norikatsu Uemura, Mamoru Doki, Yuichiro Eguchi, Hidetoshi Mizushima, Tsunekazu Ann Gastroenterol Surg Original Articles BACKGROUND: Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal‐pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed to clarify the risk factors for SOO after IPAA, focusing on the anatomical perspective. METHODS: This study included 68 UC patients who underwent IPAA with diverting ileostomy. These cases were analyzed based on clinicopathological factors and computed tomography (CT)‐based anatomical factors. RESULTS: SOO was identified in 18 patients (26.5%). We compared this SOO group with the non‐SOO group. The two groups significantly differed in sex distribution, and patients in the SOO group tended to have a longer postoperative hospital stay. Regarding surgery‐related factors, patients who underwent two‐stage surgery and experienced high‐output syndrome tended to develop SOO. Analysis of anatomical risk factors revealed that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA‐bEAS). This tendency remained significant even with adjustment for patient height. In multivariate analyses, adjusted rSMA‐bEAS (>191.0 mm/m) and male sex were independent risk factors associated with SOO. CONCLUSION: A long rSMA‐bEAS distance suggests that the mesentery is likely to be under tension. In such cases, surgeons should endeavor to avoid tension in the mesentery as much as possible. John Wiley and Sons Inc. 2021-10-13 /pmc/articles/PMC8889852/ /pubmed/35261950 http://dx.doi.org/10.1002/ags3.12512 Text en © 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterology. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Mori, Ryota Ogino, Takayuki Sekido, Yuki Hata, Tsuyoshi Takahashi, Hidekazu Miyoshi, Norikatsu Uemura, Mamoru Doki, Yuichiro Eguchi, Hidetoshi Mizushima, Tsunekazu Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title | Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title_full | Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title_fullStr | Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title_full_unstemmed | Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title_short | Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis |
title_sort | long distance between the superior mesenteric artery root and bottom of the external anal sphincter is a risk factor for stoma outlet obstruction after total proctocolectomy and ileal‐pouch anal anastomosis for ulcerative colitis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889852/ https://www.ncbi.nlm.nih.gov/pubmed/35261950 http://dx.doi.org/10.1002/ags3.12512 |
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