Pouch outcomes after minimally invasive vs. open proctectomy during IPAA reconstruction

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Oncology

Background:

• Limited data exists on pouch outcomes following minimally invasive surgery (MIS) proctectomy for restorative proctectomy with ileal pouch-anal anastomosis (IPAA).
• Comparison of MIS versus open proctectomy for IPAA regarding pouch complications is needed.

Purpose of the Study:

• To determine if MIS proctectomy is associated with different pouch complication rates compared to open proctectomy.
• To identify patient, disease, and operative factors associated with pouch complications after IPAA.

Main Methods:

• Retrospective cohort study of 117 patients undergoing restorative proctectomy with IPAA (2010-2022).
• Patients categorized into Open and Minimally Invasive Surgery (MIS) groups.
• Comparison of perioperative outcomes and rates of pouchitis, cuffitis, and pouch failure using multivariable regression.

Main Results:

• Pouchitis (37% MIS vs. 45% Open), cuffitis (32% MIS vs. 27% Open), and pouch failure (5.6% MIS vs. 6.2% Open) rates were similar between groups.
• MIS was associated with significantly lower estimated blood loss but similar length of stay and 30-day complications.
• Acute severe ulcerative colitis and high preoperative bowel movement frequency were associated with increased risk of pouchitis/cuffitis.

Conclusions:

• Minimally invasive surgery (MIS) proctectomy demonstrates equivalent long-term pouch outcomes to open proctectomy for IPAA.
• MIS may offer a reduced risk of anastomotic leak, with similar perioperative outcomes.
• Pouch complication risk is primarily linked to patient and disease factors, not the surgical approach.