AimIleorectal anastomosis (IRA) following total abdominal colectomy (TAC) allows for resortation of bowel continuity but prior studies have reported rates of anastomotic leak (AL) to be as high as 23%. We aimed to report rates of AL and complications in a large cohort of patients undergoing IRA. We hypothesized that AL rates were lower than previously reported and that selective use of diverting loop ileostomy (DLI) is associated with decreased AL rates.MethodPatients undergoing TAC or end‐ileostomy reversal with IRA, with or without DLI, between 1980 and 2021 were identified from a prospectively maintained institutional database and retrospectively analysed. Redo IRA cases were excluded. Short‐term (30‐day) surgical outcomes were collected using our database. AL was defined using a combination of imaging and, in the case of return to the operating room, intraoperative findings.ResultsOf 823 patients in the study cohort, DLI was performed in 27% and performed more frequently for constipation and inflammatory bowel disease. The overall AL rate was 3% (1% and 4% in those with and without DLI, respectively) and diversion was found to be protective against leak (OR 0.28, 95% CI 0.08–0.94, p = 0.04). However, patients undergoing diversion had a higher overall rate of postoperative complications (51% vs. 36%, p < 0.001) including superficial wound infection, urinary tract infection, dehydration, blood transfusion and portomesenteric venous thrombosis (all p < 0.04).ConclusionOur study represents the largest series of patients undergoing IRA reported to date and demonstrates an AL rate of 3%. While IRA appears to be a viable surgical option for diverse indications, our study underscores the importance of careful patient selection and thoughtful consideration of staging the anastomosis and temporary faecal diversion when necessary.

中文翻译：

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回直肠吻合术的围手术期结果 – 823 例患者的分析

目的 全腹部结肠切除术 (TAC) 后的直肠直肠吻合术 (IRA) 可以恢复肠道连续性，但之前的研究报告吻合口漏 (AL) 率高达 23%。我们的目的是报告大量接受 IRA 的患者的 AL 和并发症发生率。我们假设 AL 发生率低于之前报道的水平，并且选择性使用回肠环转造口术 (DLI) 与 AL 发生率降低相关。 方法 确定 1980 年至 2021 年间接受 TAC 或 IRA 回肠末端造口术逆转的患者，无论是否有 DLI来自前瞻性维护的机构数据库并进行回顾性分析。重做 IRA 案件被排除在外。使用我们的数据库收集短期（30 天）手术结果。 AL 的定义是结合影像学检查以及术中检查结果（如果返回手术室）。结果 在研究队列中的 823 名患者中，27% 的患者进行了 DLI，并且更频繁地因便秘和炎症性肠病而进行了 DLI。总体 AL 率为 3%（有和没有 DLI 的患者分别为 1% 和 4%），并且发现转移可以防止泄漏（OR 0.28，95% CI 0.08-0.94，p= 0.04）。然而，接受改道的患者术后并发症的总体发生率较高（51% vs. 36%，p< 0.001) 包括浅表伤口感染、尿路感染、脱水、输血和门肠系膜静脉血栓形成（全部p< 0.04)。结论我们的研究代表了迄今为止报告的最大的接受 IRA 患者系列，并显示 AL 率为 3%。虽然 IRA 似乎是针对多种适应症的可行手术选择，但我们的研究强调了仔细选择患者以及深思熟虑分期吻合和必要时临时粪便分流的重要性。