Delay in loop ileostomy reversal surgery does not impact upon post-operative clinical outcomes. Complications are associated with an increased loss of microflora in the defunctioned intestine.
Delay in loop ileostomy reversal surgery does not impact upon post-operative clinical outcomes. Complications are associated with an increased loss of microflora in the defunctioned intestine.
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DOI：
10.1080/19490976.2023.2199659
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发表时间：
2023-01
期刊：
影响因子：
12.2
通讯作者：
中科院分区：
文献类型：
--
作者：
回肠袢造口术是一种常见的外科手术，可使下游组织愈合，目的是在大约12个月后重新连接肠道。逆转手术与高达40%的发病率相关。我们之前的研究表明，功能失调的回肠会萎缩，并伴有广泛的微生物失调。本研究旨在探讨延迟回肠造口逆转手术对临床和病理结果的潜在影响。记录术后临床资料，包括血常规、住院时间、造口时间、术后并发症发生率。我们测量了回肠纤维化和萎缩，并评估了这些或生态失调是否受到造口时间的影响，或与临床结果有关。采用散点图矩阵分析和t检验调查临床资料之间的相关性。我们发现有并发症的患者与无并发症的患者在回肠造口形成和逆转的时间上没有差异。此外，出现气孔的天数与病理指标（如萎缩或纤维化）之间没有相关性，而且在逆转手术时胶原蛋白的生成也没有持续增加。这一数据表明，造口时间的长短对并发症的可能性没有影响。并发症的发生与失活回肠中微生物群损失的增加有关，但重要的是，细菌的减少与造口时间无关。个体内功能肢体和失功能肢体的微生物群多样性相关，并且在经历手术后并发症的人与没有经历手术后并发症的人之间没有显着差异。微生物群多样性也未因气孔逆转延迟（365天）而受到显著影响。我们建议，应该探索在逆转手术前恢复肠道微生物群数量的方法，而不一定是它们的组成，以改善回肠造口逆转手术的临床效果。
Loop ileostomy is a common surgical procedure to allow downstream tissue healing, with the aim of re-joining the bowel approximately 12 months later. The reversal procedure is associated with a substantial morbidity up to 40%. Our previous research demonstrated that defunctioned ileum becomes atrophied, with extensive microbial dysbiosis. This study sought to investigate the potential influence of delaying ileostomy reversal surgery upon both clinical and pathological outcomes. Post-operative clinical data was recorded, including routine blood test results, duration of hospital stay, length of time with stoma and incidence of post-operative complications. We measured ileal fibrosis and atrophy and assessed whether these, or dysbiosis, were impacted by the length of time a stoma was in place, or were linked to clinical outcomes. Associations between clinical data were investigated using scatterplot matrix analysis and t-tests. We found no differences in time between ileostomy formation and reversal in patients experiencing complications vs. individuals with no complications. Furthermore, there were no correlations between days with stoma and pathological measures, such as atrophy or fibrosis, and no ongoing increases in collagen production at the time of reversal surgery. This data suggests that the length of time a stoma is in place does not impact on the likelihood of complications. The incidence of complications is associated with increased loss of microbiota in the defunctioned ileum, but importantly, the decrease in bacteria is not linked to time with stoma. Microbiota diversity in the functional and defunctioned limb correlated within an individual, and was not significantly different between those who experienced complications following surgery vs. those that didn’t. Microbiota diversity was also not significantly impacted through delay (>365 days) in stoma reversal. We propose that methods to restore intestinal microbiota numbers, and not necessarily their composition, prior to reversal should be explored to improve the clinical outcomes of ileostomy reversal surgery.
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影响因子：
5.9
作者：
Rodríguez-Padilla Á;Morales-Martín G;Pérez-Quintero R;Gómez-Salgado J;Balongo-García R;Ruiz-Frutos C
通讯作者：
Ruiz-Frutos C
影响因子：
5.9
作者：
Bayer F;Dremova O;Khuu MP;Mammadova K;Pontarollo G;Kiouptsi K;Soshnikova N;May-Simera HL;Endres K;Reinhardt C
通讯作者：
Reinhardt C
影响因子：
29.4
作者：
GRAHAM, MF;DIEGELMANN, RF;GAY, R
通讯作者：
GAY, R
影响因子：
2.8
作者：
Chow, Andre;Tilney, Henry S.;Purkayastha, Sanjay
通讯作者：
Purkayastha, Sanjay
影响因子：
2.2
作者：
Gessler, Bodil;Haglind, Eva;Angenete, Eva
通讯作者：
Angenete, Eva