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Pelvic anastomotic stricture: what is the optimal management? An analysis of 50 consecutive patients undergoing 99 procedures
info:eu-repo/semantics/OpenAccess
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Title:
Pelvic anastomotic stricture: what is the optimal management? An analysis of 50 consecutive patients undergoing 99 procedures
Author:
Kraenzler, Axel
Subjects:
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
;
Anastomose coloanale
;
Anastomose colorectale
;
Anastomose iléoanale
;
Sténose anastomotique
Description:
Aim: To assess results of treatment for colorectal (CRA), coloanal (CAA) or ileal pouch-anal (IPAA) anastomotic stenosis (AS). Methods: All patients operated on for AS from 1995 to 2014 were included. Success was defined as the absence of new treatment for AS during 12 months after the procedure. Results: 50 patients presented AS after CRA (n=16, 32%), CAA (n=18, 36%), or IPAA (n=16, 32%), performed for colorectal cancer (n=28, 56%), familial adenomatosis polyposis (n=5, 10%), inflammatory bowel disease (n=8, 16%), diverticulitis (n=4, 8%), polyps (n=3, 6%) or miscellaneous (n=2, 4%) underwent a total number of 99 procedures including digital dilatation (n=14, 14%), instrumental (n=38, 38%), or endoscopic dilatation (n=5, 5%), anastomotic “stricturoplasty” (n=9, 9%), AS resection by circular stapler (n=11, 11%), or transabdominal redo-anastomosis (n=22, 22%). Success rates were 36% for digital dilatation, 40% for instrumental dilatation, 20% for endoscopic dilatation, 64% for resection by circular stapler, 89% for stricturoplasty, and 73% for transabdominal redoanastomosis (p=0.009). Multivariate analysis identified transabdominal redoanastamosis (OR=5 [1.4-18.7]; p=0.015) as the only independent prognostic factor for success. Conclusion: AS should be managed according to a step-up strategy. Conservative procedures are associated with acceptable success rates. However, transabdominal redoanastomosis is associated with the highest probability of success. Objectif : Évaluer les résultats du traitement des sténoses anastomotiques après anastomose iléoanale (AIA), coloanale ACA) ou colorectale (ACR). Méthodes : Tous les patients opérés pour sténose anastomotique (SA) de 1995 à 2014 ont été inclus. Le succès a été défini par l'absence de réintervention pour SA pendant 12 mois après la procédure et l’absence de stomie. Résultats : 50 patients ont présenté une SA après ACR (n = 16, 32%), ACA (n = 18, 36%), ou AIA (n = 16, 32%), réalisée soit pour cancer colorectal (n = 28, 56%), polypose adénomateuse familiale (n = 5, 10%), maladie inflammatoire de l'intestin (n = 8, 16%), maladie diverticulaire (n = 4, 8%), polypes (n = 3, 6%) ou autres (n = 2 , 4%). Il y a eu au total 99 procédures, comprenant la dilatation digitale (n = 14, 14%), la dilatation instrumentale (n = 38, 38%), la dilatation endoscopique (n = 5, 5%), la plastie d’élargissement (n = 9, 9%), la réfection par agrafage circulaire (n = 11, 11%), et les procédures chirurgicales par voie abdominale (n = 22, 22%). Les taux de réussite était de 36% pour la dilatation digitale, 40% pour la dilatation instrumentale, 20% pour la dilatation endoscopique, 64% pour la réfection par agrafage circulaire, 89% pour la plastie d’élargissement, et 73% pour les procédures chirurgicales par voie abdominale (p = 0,009). L'analyse multivariée a identifié les procédures chirurgicales par voie abdominale (OR = 5 [1,4 à 18,7]; p = 0,015) comme le seul facteur pronostique indépendant de réussite. Conclusion : La SA devrait être gérée selon une stratégie progressive. Les procédures conservatrices sont associées à des taux de réussite acceptables. Cependant, les procédures chirurgicales par voie abdominale sont associées à la plus forte probabilité de succès.
Publisher:
HAL CCSD
Creation Date:
2015
Language:
French
Source:
Dumas (Dépôt Universitaire de Mémoires Après Soutenance)
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