gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctologygnck-1716Research ArticleСтатьиНеэффективность тазовых тонкокишечных резервуаров у больных язвенным колитомPouch failure of ileal pouch in patients with ulcerative colitisКуликовАртур ЭдуардовичKulikovArtur E.polikarpova-e@yandex.ru1Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр колопроктологии имени А.Н. Рыжих» Минздрава России (ул. Саляма Адиля, д.2, г.Москва,123423, Россия) 2Клинический госпиталь «Лапино» группы компаний «Мать и дитя» (1-е Успенское шоссе, д.111, дер.Лапино, Московская обл., 143081 Россия)Россия1Ryzhikh National Medical Research Center of Coloproctology (Salyama Adilya str., 2, Moscow, 123423, Russia) 2Clinical Hospital “Lapino” of the “Mother and Child” Group of companies (111 1st Uspenskoe Shosse, Lapino, Moscow region 143081, Russia)Russian Federation2022210920222131716Copyright © Куликов А.Э., 20222022Куликов А.Э.Kulikov A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1716ЦЕЛЬ

ЦЕЛЬ: улучшение результатов лечения больных язвенным колитом (ЯК), перенесших формирование тазовых тонкокишечных резервуаров (ТТР).

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: в ретроспективное одноцентровое исследование включено 144 пациента, которым в период с 2011 по 2018 год в ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава России был сформирован тазовый тонкокишечный резервуар. Медиана наблюдения за пациентами с ТТР составила 32 (20; 43) месяца. 4 пациента отказались от закрытия превентивной илеостомы по немедицинским причинам, поэтому анализ частоты, факторов риска неэффективности резервуара (НР) был проведен в группе из 140 больных.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: Неэффективность резервуара констатируется при невозможности закрыть илеостому через 12 и более месяцев после формирования ТТР. Ее развитие констатировано у 30(21,4%) из 140 пациентов.

Независимым фактором, повышающим риск развития резервуар-ассоциированных осложнений, приводящих к НР, оказалась: гипоальбуминемия на момент формирования ТТР (ОШ = 5,74; 95% ДИ 1,83 – 18,01; p=0,003). Резервуарный свищ (ОШ = 127,93; 95% ДИ 19,86 -824,07; p<0,001), несостоятельность швов ТТР (ОШ = 5,55; 95% ДИ 1,06 -29,14; p=0,043)и тонкокишечная непроходимость (ОШ = 13,72; 95% ДИ 2,86 -65,87; p=0,001) были определены, как независимые факторы риска наступления НР.

Лечение осложнений у 11(36,7%) из 30 больных было эффективно и позволило преодолеть НР и закрыть илеостому. В 8(26,6%) случаях ТТР был удален, а у 11(36,7%) пациентов илеостома не была закрыта.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: Анализ результатов нашего исследования показал, что единственным фактором риска развития осложнений, приведших к НР, была гипоальбуминемия. Формирование резервуарного свища, несостоятельность швов ТТР, и тонкокишечная непроходимость оказались независимыми факторами, статистически значимо повышающими вероятность развития НР.

Ликвидация осложнений, ассоциированных с ТТР, позволила у 11(36,7%) из 30 пациентов преодолеть НР, закрыть илеостому и восстановить анальную дефекацию. У 8(5,7%) из 140 больных пришлось прибегнуть к удалению ТТР и сформировать им перманентную илеостому.

AIM

AIM: the purpose of this study is figure out around "pouch failure" including time of its onset, identify risk factors of "pouch failure", as well as evaluation of the effectiveness of treatment of complications that led to "pouch failure"  in patients with ulcerative colitis.

PATIENTS AND METHODS

PATIENTS AND METHODS: the retrospective single-center study included 144 patients from 2011 to 2018, who had J-pouch surgery at the Ryzhikh National Medical Research Center of Coloproctology Median time of follow-up of patients with J-pouch - 32 (20; 43) months.

RESULTS

RESULTS: the definition of «pouch failure» was phrased as the condition, which develops when J-pouch associated complications are being shown and requires switch off J-pouch by removing of pouch or ileostomy or ileostomy won’t being able to closed during 12 months or more.

The multivariate analysis has shown that hypoalbuminemia was independent risk factor of «pouch failure» OR = 5,74, 95% CI 1,83 – 18,01, p=0,003. Also multivariate analysis of pouch associated complications impact to risk of «pouch failure» was performed and those have statistically significant higher risk of «pouch failure»: pouch associated fistula – OR = 127,93, 95% CI19,86 -824,07, p=0,0000003, ileal-pouch anastomosis leakage - OR = 5,55, 95% CI1,06 -29,14, p=0,043, and ileus - OR = 13,72, 95% CI2,86 -65,87, p=0,001.

Among 30 patients with «pouch failure»: 11(36,7%) cases ileostomy wasn’t closed, but pouch was saved, in 8 (26,6%) cases pouch was removed. In 5(16,7%) J-pouch was removed due to refusing of «pouch salvage surgery».

CONCLUSION

CONCLUSION: identification of risk factors of «pouch failure» is still actual problem. Our study has identified definition of «pouch failure» and time of its onset, also risk factors of «pouch failure» was found out and results of the treatment of pouch complications was got. That would be really helpful to continue this study with more patients and longer time of follow-up for getting more evidences.

язвенный колиттонкокишечный резервуаросложнениянеэффективность резервуарафакторы рискаulcerative colitisileal pouchcomplicationspouch failurerisk factorsReferencesParks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. British medical journal. 1978;2:85–8.Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. British medical journal. 1978;2:85–8.Andersson P, Söderholm JD. Surgery in ulcerative colitis: indication and timing. Digestive diseases (Basel, Switzerland). 2009;27:335–40. https://doi.org/10.1159/000228570.Andersson P, Söderholm JD. Surgery in ulcerative colitis: indication and timing. Digestive diseases (Basel, Switzerland). 2009;27:335–40. https://doi.org/10.1159/000228570.Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, et al. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Disease. 2007;9:310–20. https://doi.org/10.1111/j.1463-1318.2006.01093.x.Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, et al. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Disease. 2007;9:310–20. https://doi.org/10.1111/j.1463-1318.2006.01093.x.Шелыгин Ю.А., Кашников В.Н., Сушков О.И., Гусев А.В., и соавт. Тонкокишечные резервуары в реабилитации больных язвенным колитом. Колопроктология. 2014;49:50–6.Shelygin Yu.A., Kashnikov V.N., Sushkov O.I., Gusev A.V., et al. Small intestinal reservoirs in the rehabilitation of patients with ulcerative colitis. Koloproktologia. 2014;49:50–6.Alexander F. Complications of ileal pouch anal anastomosis. Seminars in pediatric surgery. 2007;16:200–4. https://doi.org/10.1053/j.sempedsurg.2007.04.009Alexander F. Complications of ileal pouch anal anastomosis. Seminars in pediatric surgery. 2007;16:200–4. https://doi.org/10.1053/j.sempedsurg.2007.04.009Ачкасов С.И., Сушков О.И., Куликов А.Э., Биннатли Ш.А., и соавт. Факторы риска развития осложнений тазовых тонкокишечных резервуаров у больных язвенным колитом. Колопроктология. 2020;19:51–66. https://doi.org/10.33878/2073-7556-2020-19-1-51-66Achkasov S.I., Sushkov O.I., Kulikov A.E., Binnatli S.A., et al. Risk factors for the development of complications of pelvic small intestinal reservoirs in patients with ulcerative colitis. Koloproktologia. 2020;19:51–66.https://doi.org/10.33878/2073-7556-2020-19-1-51-66Sherman J, Greenstein AJ, Greenstein AJ. Ileal j pouch complications and surgical solutions: a review. Inflammatory bowel diseases. 2014;20:1678–85. https://doi.org/10.1097/MIB.0000000000000086Sherman J, Greenstein AJ, Greenstein AJ. Ileal j pouch complications and surgical solutions: a review. Inflammatory bowel diseases. 2014;20:1678–85. https://doi.org/10.1097/MIB.0000000000000086Биннатли Ш.А., Алешин Д.В., Куликов А.Э., Романов Р.И. Качество жизни пациентов, оперированных по поводу язвенного колита (обзор литературы). Колопроктология. 2019;18:89–100. https://doi.org/10.33878/2073-7556-2019-18-1-89-100Binnatli Sh.A., Aleshin D.V., Kulikov A.E., Romanov R.I. Quality of life of patients operated on for ulcerative colitis (literature review). Koloproktologia. 2019;18:89–100. https://doi.org/10.33878/2073-7556-2019-18-1-89-100Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6.Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6.Zittan E, Wong-Chong N, Ma GW, McLeod RS, Silverberg MS, Cohen Z. Modified two-stage ileal pouch-anal anastomosis results in lower rate of anastomotic leak compared with traditional two-stage surgery for ulcerative colitis. Journal of Crohn’s and Colitis. 2016;10:766–72. https://doi.org/10.1093/ecco-jcc/jjw069Zittan E, Wong-Chong N, Ma GW, McLeod RS, Silverberg MS, Cohen Z. Modified two-stage ileal pouch-anal anastomosis results in lower rate of anastomotic leak compared with traditional two-stage surgery for ulcerative colitis. Journal of Crohn’s and Colitis. 2016;10:766–72. https://doi.org/10.1093/ecco-jcc/jjw069Nisar PJ, Kiran RP, Shen B, Remzi FH, Fazio VW. Factors Associated With Ileoanal Pouch Failure in Patients Developing Early or Late Pouch-Related Fistula. Diseases of the Colon & Rectum. 2011;54:446–53. https://doi.org/10.1007/DCR.0b013e318206ea42.Nisar PJ, Kiran RP, Shen B, Remzi FH, Fazio VW. Factors Associated With Ileoanal Pouch Failure in Patients Developing Early or Late Pouch-Related Fistula. Diseases of the Colon & Rectum. 2011;54:446–53. https://doi.org/10.1007/DCR.0b013e318206ea42.Mark-Christensen A, Erichsen R, Brandsborg S, Pachler FR, Nørager CB, Johansen N, идр. Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis. Colorectal Disease 2018;20:44–52. https://doi.org/10.1111/codi.13802Mark-Christensen A, Erichsen R, Brandsborg S, Pachler FR, Nørager CB, Johansen N, идр. Pouch failures following ileal pouch–anal anastomosis for ulcerative colitis. Colorectal Disease 2018;20:44–52. https://doi.org/10.1111/codi.13802Leowardi C, Hinz U, Tariverdian M, Kienle P, et al. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis. Langenbeck’s Archives of Surgery. 2010;395:49–56. https://doi.org/10.1007/s00423-009-0479-7Leowardi C, Hinz U, Tariverdian M, Kienle P, et al. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch–anal anastomosis in patients with ulcerative colitis. Langenbeck’s Archives of Surgery. 2010;395:49–56. https://doi.org/10.1007/s00423-009-0479-7Helavirta I, Lehto K, Huhtala H, Hyöty M, et al. Pouch failures following restorative proctocolectomy in ulcerative colitis. International journal of colorectal disease. 2020;35:2027–33. https://doi.org/10.1007/S00384-020-03680-1Helavirta I, Lehto K, Huhtala H, Hyöty M, et al. Pouch failures following restorative proctocolectomy in ulcerative colitis. International journal of colorectal disease. 2020;35:2027–33. https://doi.org/10.1007/S00384-020-03680-1Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6Alsafi Z, Snell A, Segal JP. Prevalence of «pouch failure» of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. International journal of colorectal disease. 2021. https://doi.org/10.1007/S00384-021-04067-6Meagher AP, Farouk R, Dozois RR, Kelly KA, et el. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. The British journal of surgery. 1998;85:800–3. https://doi.org/10.1046/j.1365-2168.1998.00689.xMeagher AP, Farouk R, Dozois RR, Kelly KA, et el. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. The British journal of surgery. 1998;85:800–3. https://doi.org/10.1046/j.1365-2168.1998.00689.xIshii H, Kawai K, Hata K, Shuno Y, Nishikawa T, et al. Comparison of functional outcomes of patients who underwent hand-sewn or stapled ileal pouch-anal anastomosis for ulcerative colitis. International Surgery. 2015;100:1169–76. https://doi.org/10.9738/INTSURG-D-15-00012.1Ishii H, Kawai K, Hata K, Shuno Y, Nishikawa T, et al. Comparison of functional outcomes of patients who underwent hand-sewn or stapled ileal pouch-anal anastomosis for ulcerative colitis. International Surgery. 2015;100:1169–76. https://doi.org/10.9738/INTSURG-D-15-00012.1Forbes SS, O’Connor BI, Charles Victor J, Cohen Z, et al. Sepsis is a major predictor of failure after ileal pouch-anal anastomosis. Diseases of the Colon and Rectum. 2009;52:1975–81. https://doi.org/10.1007/DCR.0b013e3181beb3f0Forbes SS, O’Connor BI, Charles Victor J, Cohen Z, et al. Sepsis is a major predictor of failure after ileal pouch-anal anastomosis. Diseases of the Colon and Rectum. 2009;52:1975–81. https://doi.org/10.1007/DCR.0b013e3181beb3f0

The authors declare that there are no conflicts of interest present.