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Master Thesis

Sténose d’anastomose iléoanale, coloanale ou colorectale : quelle est la meilleure prise en charge ? Une analyse de 99 procédures chez 50 patients consécutifs

Abstract : Aim: To assess results of treatment for colorectal (CRA), coloanal (CAA) or ileal pouch-anal (IPAA) anastomotic stenosis (AS). Methods: All patients operated on for AS from 1995 to 2014 were included. Success was defined as the absence of new treatment for AS during 12 months after the procedure. Results: 50 patients presented AS after CRA (n=16, 32%), CAA (n=18, 36%), or IPAA (n=16, 32%), performed for colorectal cancer (n=28, 56%), familial adenomatosis polyposis (n=5, 10%), inflammatory bowel disease (n=8, 16%), diverticulitis (n=4, 8%), polyps (n=3, 6%) or miscellaneous (n=2, 4%) underwent a total number of 99 procedures including digital dilatation (n=14, 14%), instrumental (n=38, 38%), or endoscopic dilatation (n=5, 5%), anastomotic “stricturoplasty” (n=9, 9%), AS resection by circular stapler (n=11, 11%), or transabdominal redo-anastomosis (n=22, 22%). Success rates were 36% for digital dilatation, 40% for instrumental dilatation, 20% for endoscopic dilatation, 64% for resection by circular stapler, 89% for stricturoplasty, and 73% for transabdominal redoanastomosis (p=0.009). Multivariate analysis identified transabdominal redoanastamosis (OR=5 [1.4-18.7]; p=0.015) as the only independent prognostic factor for success. Conclusion: AS should be managed according to a step-up strategy. Conservative procedures are associated with acceptable success rates. However, transabdominal redoanastomosis is associated with the highest probability of success.
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Master Thesis
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Submitted on : Thursday, December 17, 2015 - 3:57:37 PM
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Axel Kraenzler. Sténose d’anastomose iléoanale, coloanale ou colorectale : quelle est la meilleure prise en charge ? Une analyse de 99 procédures chez 50 patients consécutifs. Médecine humaine et pathologie. 2015. ⟨dumas-01245755⟩

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