Incidence of complications following colectomy with mesenteric closure versus no mesenteric closure: does it really matter?

摘要

BACKGROUND: There remains strong opinion but very little data to support the way that the resultant mesenteric defect is handled following colectomy. Despite case reports of internal hernias and subsequent bowel obstruction requiring operative intervention, no larger series have evaluated this question. MATERIALS AND METHODS: Retrospective review of elective right and left/sigmoid colectomies during the period from 2004 to 2007. Patients were stratified by the method of handling the mesenteric defect (open versus closed), with the primary endpoint of complications potentially directly attributable to the closure or failure to close the mesenteric defect. Preoperative and intraoperative risk factors were also analyzed as covariables. RESULTS: One hundred thirty-three patients (76 male; 57 female; mean age 59+/-15 years) with a median follow-up of 39.5 mo were identified. Thirty-six percent underwent a right hemicolectomy, 33% sigmoidectomy, 11% left hemicolectomy, 9% low anterior resection, and 5% ileocectomy. Overall, 24% of the surgeries were done laparoscopically and 52% had their mesenteric defect closed. The overall complication rate was 27.8% and eight patients (6%) developed a postoperative complication near the mesenteric defect (anastomotic leakage or small bowel obstruction). By multivariate analysis, mesenteric defect closure was the only significant factor identified with the development of complications near the mesenteric defect (OR=5.5; 95% CI 1.069-28.524, P=0.041). No other preoperative or intraoperative factors were found to have an impact on the complication rate. CONCLUSION: Closure of the mesenteric defect was associated with a higher rate of complications, and demonstrated no benefit in abdominal colectomy.