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Primary Versus Stag...
Primary Versus Staged Reconstruction and Risk of Surgical Failure in Patients With Ulcerative Colitis : a Nation-wide Cohort Study
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- Westberg, Karin (author)
- Karolinska Institutet
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- Olén, Ola (author)
- Karolinska Institutet
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- Söderling, Jonas (author)
- Karolinska Institutet
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- Bengtsson, Jonas (author)
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrens Univ Hosp, Sweden
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- Ludvigsson, Jonas F., 1969- (author)
- Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden,Karolinska Inst, Sweden; Orebro Univ Hosp, Sweden
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- Everhov, Åsa H. (author)
- Karolinska Institutet
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- Myrelid, Pär (author)
- Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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- Nordenvall, Caroline (author)
- Karolinska Institutet
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(creator_code:org_t)
- 2021-11-18
- 2022
- English.
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In: Inflammatory Bowel Diseases. - : Oxford University Press. - 1078-0998 .- 1536-4844. ; 28:9, s. 1301-1308
- Related links:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Subject headings
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- Lay Summary: This population-based study of 2172 patients treated with colectomy for ulcerative colitis shows that a colectomy and restorative IRA/IPAA surgery performed simultaneously entails a higher risk of failure than when reconstruction is performed later.Background: Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary and staged reconstruction.Methods: This is a national register-based cohort study of all patients 15 to 69 years old in Sweden treated with colectomy due to UC and who received an ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) between 1997 and 2017. Failure was defined as a reoperation with new ileostomy after restorative surgery or a remaining defunctioning ileostomy after 2 years. Risk of failure was calculated using the Kaplan-Meier method and Cox regression adjusted for sex, age, calendar period, primary sclerosing cholangitis, and duration of UC.Results: Of 2172 included patients, 843 (38.8%) underwent primary reconstruction, and 1329 (61.2%) staged reconstruction. Staged reconstruction was associated with a decreased risk of failure compared with primary reconstruction (hazard ratio, 0.73; 95% CI, 0.58-0.91). The 10-year cumulative risk of failure was 15% vs 20% after staged and primary reconstruction, respectively. In all, 1141 patients (52.5%) received an IPAA and 1031 (47.5%) an IRA. In stratified multivariable models, staged reconstruction was more successful than primary reconstruction in both IRA (hazard ratio, 0.75; 95% CI, 0.54-1.04) and IPAA (hazard ratio, 0.73; 95% CI, 0.52-1.01), although risk estimates failed to attain statistical significance.Conclusions: In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Keyword
- ulcerative colitis
- restorative surgery
- failure
- ileal pouch anal anastomosis
- ileorectal anastomosis
Publication and Content Type
- ref (subject category)
- art (subject category)
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