Complications and failure after Kock continent ileostomy: A systematic review and meta-analysis

被引:0
作者
Emile, S. H. [1 ,2 ]
Garoufalia, Z. [1 ]
Mavrantonis, S. [3 ]
Rogers, P. [1 ]
Barsom, S. H. [4 ]
Horesh, N. [1 ,5 ]
Gefen, R. [1 ,6 ,7 ]
Wexner, S. D. [1 ]
机构
[1] Cleveland Clin Florida, Ellen Leifer Shulman & Steven Shulman Digest Dis C, 2950 Cleveland Clin Blvd, Weston, FL 33331 USA
[2] Mansoura Univ Hosp, Gen Surg Dept, Colorectal Surg Unit, Mansoura, Egypt
[3] Barts & London Queen Marys Sch Med & Dent, London, England
[4] Univ South Dakota, Sanford Sch Med, Internal Med Dept, Sioux Falls, SD USA
[5] Sheba Med Ctr, Dept Surg & Transplantat, Ramat Gan, Israel
[6] Hebrew Univ Jerusalem, Dept Gen Surg, Hadassah Med Org, Jerusalem, Israel
[7] Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel
关键词
Kock pouch; Continent ileostomy; Complications; Failure; Systematic review; Meta-analysis; QUALITY-OF-LIFE; LONG-TERM OUTCOMES; RESTORATIVE PROCTOCOLECTOMY; FOLLOW-UP; POUCH; DURABILITY; RESERVOIR;
D O I
10.1007/s10151-024-03018-x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BackgroundA significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP.MethodsThis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review (CRD42023416961) searched PubMed, Scopus, and Web of Science for studies on adult patients with Kock continent ileostomy published after the year 2000. The main outcome measures were revision, complications, and failure of the KP. Risk factors for complications and failure were assessed using a meta-regression analysis. Risk of bias was assessed using the ROBINS-1 tool. A proportional meta-analysis of the main outcomes was performed.ResultsA total of 19 studies (2042 patients) were included. The weighted mean prevalence of complications was 60.4% [95% confidence interval (CI): 46.1-74.7%], of pouch revision was 46.6% (95% CI: 38.5-54.7%), and of pouch failure was 12.9% (95% CI: 9.3-16.4%). Studies conducted in the USA had a mean failure prevalence of 12.6% (95% CI: 6.2-18.9%) comparable to studies conducted in Europe (11.1%; 95% CI: 7.5-14.7%). Factors associated with higher complications were increased body mass index (BMI) and previous ileoanal pouch anastomosis (IPAA); however, these factors were not associated with increased pouch failure.ConclusionsThe KP is a highly complex operation as shown by a pooled complication prevalence of 60%, and thus, it should be only performed by experienced surgeons. Despite the high prevalence of complications and need for revisional surgery, patients are keen to preserve their KP. Increased BMI and a previous failed IPAA are risk factors for pouch complications, but not failure.
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页数:10
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