Ten steps for ileoanal pouch anastomosis

Area of Science:

• Colorectal Surgery
• Surgical Technique Optimization
• Minimally Invasive Procedures

Background:

• Ileoanal pouch surgery (IPAA) is crucial for managing ulcerative colitis, but requires precise surgical technique for optimal outcomes.
• Patient selection, surgical skill, and follow-up are key factors influencing functional results and quality of life after IPAA.
• Standardized approaches can enhance surgical proficiency and reduce variability in complex procedures.

Purpose of the Study:

• To demonstrate a standardized, 10-step laparoscopic approach for ileoanal pouch formation developed at a specialized pouch surgery center.
• To provide a structured framework for surgeons, particularly those in the learning curve, for performing ileoanal pouch anastomosis (IPAA).

Main Methods:

• A structured, 10-step laparoscopic proctectomy with ileoanal pouch anastomosis formation was developed.
• Thirty-eight consecutive ulcerative colitis patients referred to the center between January 2020 and December 2022 were included.
• All procedures were performed laparoscopically, with a single conversion to open surgery.

Main Results:

• Thirty-eight patients underwent laparoscopic ileal pouch-anal anastomosis (IPAA), with a 2.6% conversion rate to open surgery.
• Postoperative complications within 30 days occurred in 34.2% of patients (13/38), with 15.8% (6/38) being Clavien-Dindo grade 3 or higher.
• At 12 months post-surgery, the median number of bowel movements per 24 hours was 4 (range 1-11), with a median follow-up of 18 months.

Conclusions:

• The modular 10-step approach offers a standardized framework for surgeons learning the IPAA technique.
• Despite the complexity and potential morbidity of IPAA, this stepwise method facilitates minimally invasive surgery.
• The standardized approach may contribute to improved functional outcomes and facilitate the adoption of laparoscopic IPAA.