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Laparoscopic versus open ileal Pouch-Anal anastomosis in paediatric patients: A systematic review and meta-analysis
Salvatore Arena1, Giada Loria1, Fabiola Cassaro2
1Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Messina, Italy.
Insights
Laparoscopic ileal pouch-anal anastomosis (L-IPAA) in young patients offers reduced hospital stays compared to open surgery (O-IPAA), with similar complication rates. Longer operative times for L-IPAA are noted, but benefits in recovery are significant.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pediatric Surgery
Background:
- Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is the standard for colonic pathologies.
- Laparoscopic IPAA (L-IPAA) is increasingly used in young patients, but its benefits over open IPAA (O-IPAA) are unclear.
Purpose of the Study:
- To compare outcomes of L-IPAA versus O-IPAA in patients under 21.
- Focus on complications, operative time, and hospital length of stay (LOS).
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Included comparative studies of patients <21 years undergoing IPAA.
- Analyzed major/minor complications, operative time, and LOS using random-effects models.
Main Results:
- No significant difference in major intra- or post-operative complications between L-IPAA and O-IPAA.
- L-IPAA showed a trend toward fewer minor complications and significantly shorter LOS.
- L-IPAA had a significantly longer operative time; evidence certainty was low to moderate.
Conclusions:
- Both L-IPAA and O-IPAA are safe and effective for pediatric/young adult total proctocolectomy.
- L-IPAA reduces hospital stay with comparable complications, despite longer operative time.
- Further multicenter randomized trials are needed to confirm optimal surgical approach.
Background:
Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, familial adenomatous polyposis, and other colonic pathologies. The laparoscopic approach (L-IPAA) has been increasingly utilized in pediatric and young adult populations to enhance recovery and reduce morbidity; however, its benefits over open surgery (O-IPAA) remain uncertain. This meta-analysis aimed to compare outcomes between L-IPAA and O-IPAA, focusing on complications, operative time, and length of hospital stay (LOS).
Methods:
A systematic review and meta-analysis were performed according to PRISMA guidelines, including comparative studies of patients <21 years undergoing IPAA. Databases searched included PubMed, Ovid, and Cochrane CENTRAL up to September 2025. Primary outcomes were major intra- and post-operative complications; secondary outcomes included minor complications, operative time, and LOS. Data were analyzed using random-effects models, with risk of bias assessed via ROBINS-I and evidence quality graded using the GRADE system.
Results:
Eight studies encompassing 1094 patients met inclusion criteria: 412 underwent O-IPAA and 682 underwent L-IPAA. No significant differences were found in major intra-operative (OR = 0.871, p = 0.888) or major post-operative complications (OR = 0.798, p = 0.599). L-IPAA showed a trend toward fewer minor complications (OR = 0.514, p = 0.071) and demonstrated a significantly shorter hospital stay (OR = 0.480, p < 0.001). Operative time was significantly longer in the laparoscopic group (OR = 1.784, p < 0.001). Heterogeneity across studies was moderate to high, and the overall certainty of evidence ranged from very low to moderate.
Conclusion:
Both laparoscopic and open IPAA are safe and effective for pediatric and young adult patients requiring total proctocolectomy. While laparoscopic surgery entails a longer operative time, it offers a clear benefit in reducing hospital stay, with comparable complication rates. Further multicenter randomized studies are needed to validate these findings and define the optimal surgical approach.
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