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Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis

BACKGROUND/AIMS: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. METHODS:...

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Detalles Bibliográficos
Autores principales: Emoto, Shigenobu, Hata, Keisuke, Nozawa, Hiroaki, Kawai, Kazushige, Tanaka, Toshiaki, Nishikawa, Takeshi, Shuno, Yasutaka, Sasaki, Kazuhito, Kaneko, Manabu, Murono, Koji, Iida, Yuuki, Ishii, Hiroaki, Yokoyama, Yuichiro, Anzai, Hiroyuki, Sonoda, Hirofumi, Ishihara, Soichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association for the Study of Intestinal Diseases 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344241/
https://www.ncbi.nlm.nih.gov/pubmed/33902266
http://dx.doi.org/10.5217/ir.2020.00158
Descripción
Sumario:BACKGROUND/AIMS: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. METHODS: Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of non-reaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated. RESULTS: Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching. CONCLUSIONS: Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.