S100 Long-Term Outcomes of S-Pouch Configured Ileal Pouch-Anal Anastomosis
Notice bibliographique
Résumé
Background: The ileal pouch-anal anastomosis (IPAA) is the gold standard for restoration of intestinal continuity after a total proctocolectomy, with the J-pouch most commonly used. S-pouches are more recently infrequently performed, and often in the setting of mesenteric length problems. We analyzed the indications and outcomes of S-pouches in the prior to and since the 21st century. Methods: A prospectively maintained pouch database (1983 - 2015) was queried to identify patients with an S-pouch with underlying inflammatory bowel disease. The cohort was stratified into groups based on the time of operation: before 2000 (group 1) and after 2000 (group 2). Patients’ demographics, postoperative complications, cumulative Kaplan – Meier pouch survival, function, and quality of life (QoL) were analyzed. Results: A total of 349 patients were identified: group 1 – 314 patients and group 2 – 35 patients. The median follow-up in group 1 was 12 years (16-24) vs 4 (2-10) years in group 2 (P < 0.001). Patients were comparable in terms of age, gender, BMI, and ASA scores (all p>0.05). The histopathological diagnoses were also similar in group 1 (UC 77%, CD 10%, IC 13%) vs group 2 (UC 65%, CD 6%, IC 29%), P = 0.07. The median preoperative duration of IBD was significantly longer in group 2: 11(4 - 18) years vs group 1: 7 (3-11), P < 0.001. Group 1 was treated with steroids more (62% vs 25%, P < 0.001). The majority underwent colectomy for medically refractory disease; however, dysplasia was present more in group 2 (28% vs 14%), P < 0.001. After 2000, the 3-stage approach was utilized more frequently: 18.5% vs 31%; P = 0.01. Single-stage IPAA were more common in group 1 (5% vs 0%), while handsewn anastomoses were more common in group 2: 69% vs 36%, P = 0.003. The majority had challenges reaching the pelvis leading to S-pouch creation with 37% patients in group 2 sighting bulky and short mesentery due to obesity and had proximal stoma creation. The median hospital length of stay was significantly longer in the group 1: 9 (8-11) days compared to group 2: 5 (4-6.5) days, P < 0.001. The overall morbidity was similar between the groups (group 1 vs group 2, 85% vs 74%, P = 0.12). There were significantly more anastomotic separations in group 2: 25% compared to group 1 (5%), P = 0. 001. The rates of anastomotic stricture and fistula were comparable. The estimated Kaplan-Meier pouch survival was better in group 1 compared to group 2: at 1-year (99% vs 90%), 5-years (96% vs 85%), and at 10-years (94% vs 85.3%), respectively, P = 0.001. The number of stools were also comparable between the groups, group 1 vs 2: 6 (4-9) vs 6 (5-9), P = 0.81. The quality of life did not differ in group 2 vs 1: 0.7 (0.6 – 0.9) vs 0.8 (0.7 – 0.9), P = 0.18. Conclusion(s): S-pouches are less frequently used since 2000, with more recent S-pouch construction showing higher rates of leak and pelvic sepsis yet allowing adequate reach to allow pouch construction in most patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».