Transanal Versus Transabdominal Minimally Invasive (Completion) Proctectomy With Ileal Pouch-anal Anastomosis in...

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Transanal dissection advances rectal cancer surgery, improving distal rectal exposure and outcomes.
• This approach has been adapted for ulcerative colitis (UC) patients, aiming to reduce invasiveness.

Purpose of the Study:

• To compare the surgical outcomes of transanal ileal pouch-anal anastomosis (ta-IPAA) versus transabdominal minimally invasive approaches for ulcerative colitis (UC).
• To evaluate outcomes using the comprehensive complication index (CCI).

Main Methods:

• Retrospective analysis of patients undergoing minimally invasive restorative proctocolectomy (multiport, single port, hand-assisted, robotic) between 2011 and 2016.
• Comparison of CCI within 90 days post-pouch construction between transanal and transabdominal approaches.

Main Results:

• Ninety-seven patients in the ta-IPAA group were compared to 119 in the transabdominal IPAA group.
• The ta-IPAA group had significantly lower odds of postoperative morbidity (OR 0.52, P=0.026).
• Mean CCI was not significantly different between groups when morbidity was present, but overall CCI scores favored ta-IPAA.

Conclusions:

• Transanal ileal pouch-anal anastomosis (ta-IPAA) is a safe procedure for ulcerative colitis.
• ta-IPAA results in fewer patients experiencing morbidity compared to transabdominal approaches.
• While complication severity is comparable when present, ta-IPAA leads to lower overall complication index scores.