Colectomy with ileorectal anastomosis has a worse 30‐day outcome when performed for colonic inertia than for a neoplastic indication

Reshef, A; Gurland, Brooke; Zutshi, Massarat; Kiran, Ravi P.; Hull, Tracy L.

doi:10.1111/codi.12058

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…Procedures considered beyond the scope of systematic review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] were: 1 Total colonic and rectal excision (proctocolectomy).…”

Section: Scopementioning

confidence: 99%

Surgery for constipation: systematic review and practice recommendations

et al. 2017

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Aim To assess the outcomes of colectomy in adults with chronic constipation (CC).Method Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements (SES) with a summative Oxford Centre for EvidenceBased Medicine (2009) level.Results Forty articles were identified, providing data on outcomes in 2045 patients. Evidence was derived almost exclusively from observational studies, the majority of which concerned colectomy and ileorectal anastomosis (CIRA) rather than other procedural variations. Average length of stay (LOS) ranged between 7-15 days. Although inconsistent, laparoscopic surgery may be associated with longer mean operating times (210 vs 167 min) and modest decreases in LOS (10-8 days). Complications occurred in approximately 24% of patients. Six (0.4%) procedure-related deaths were observed. Recurrent episodes of small bowel obstruction occurred in about 15% (95%CI: 10-21%) of patients in the long-term, with significant burden of rehospitalisation and frequent recourse to surgery. Most patients reported a satisfactory or good outcome after colectomy but negative long-term functional outcomes persist in a minority of patients. The influence of resection extent, anastomotic configuration and method of access on complication rates remains uncertain. Available evidence weakly supports selection of patients with an isolated slow-transit phenotype.Conclusion Colectomy for CC may benefit some patients but at the cost of substantial short-and longterm morbidity. Current evidence is insufficient to guide patient or procedural selection.

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“…Procedures considered beyond the scope of systematic review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] were: 1 Total colonic and rectal excision (proctocolectomy).…”

Section: Scopementioning

confidence: 99%

Surgery for constipation: systematic review and practice recommendations

et al. 2017

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“…The average length of hospital stay after open colectomy is about 6 days in the United States and convalescence can take up to 2 months. Laparoscopic technique has improved these outcomes but the risks of colectomy are still important to consider .…”

Section: Risks Of Surgerymentioning

confidence: 99%

Prophylactic colectomy: Rationale, indications, and approach

Kalady

Church

2014

Journal of Surgical Oncology

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Discerning the genetics of hereditary colorectal cancer syndromes has enabled a more individualized approach to preventing and treating colorectal cancers in affected patients and families. As these syndromes carry significant risk of colorectal cancer (nearly 100% in some cases), prophylactic colectomy is an important option for preventing cancer. This article addresses the rationale and indications for prophylactic colectomy in hereditary colorectal cancer syndromes, and provides insight into the details of surgical management.

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“…We read with great interest the article entitled ‘Colectomy with ileorectal anastomosis has a worse 30‐day outcome when performed for colonic inertia than for a neoplastic indication', authored by Reshef et al . . As pointed out by the authors, colectomy with ileorectal anastomosis for colonic inertia is associated with a high rate of postoperative morbidity compared with patients undergoing the same procedure for neoplastic indication (19%).…”

mentioning

confidence: 92%

“…The definition of colonic inertia varies between centres, from delayed colonic transit identified using radio‐opaque markers to characterized colonic motility disturbance assessed using colonic manometry. In the study of Reshef et al ., it is not completely clear which definition was used for the diagnosis of colonic inertia . In any case, colectomy with ileorectal anastomosis should be considered only in patients with medically refractory constipation.…”

mentioning

confidence: 99%

“…Therefore, it would be interesting to know in the study of Reshef et al . whether patients with prolonged postoperative ileus underwent other GI motility/transit measurements before surgery or not. In our view manometry of the small bowel should at least be considered in such severe and selected patients to identify patients with a high risk of postoperative ileus or recurrent small bowel obstruction.…”

mentioning

confidence: 99%

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