Transanal completion proctectomy with close rectal dissection and ileal pouch‐anal anastomosis for ulcerative colitis

Souzani, Katarina Levic; Nielsen, Claus Buhl; Bulut, Orhan

doi:10.1111/ases.12646

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…Table 1, [10][11][12][13][14][15][16][17] [24][25][26][27][28][29] highlight the main characteristics of the studies identified in the systematic review.…”

Section: Resultsmentioning

confidence: 99%

Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques

Kotze,

Avellaneda,

Moretti

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques. OBJECTIVE: To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy. DATA SOURCE: Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. STUDY SELECTION: Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis. INTERVENTION: IPAA technique. MAIN OUTCOME MEASURES: Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function). RESULTS: Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors’ discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques. LIMITATIONS: A low number of studies with handsewn IPAA technique and a large number of studies added at authors’ discretion were the limitations of this strudy. CONCLUSIONS: Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.

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“…Table 1, [10][11][12][13][14][15][16][17] [24][25][26][27][28][29] highlight the main characteristics of the studies identified in the systematic review.…”

Section: Resultsmentioning

confidence: 99%

Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques

Kotze,

Avellaneda,

Moretti

et al. 2024

Diseases of the Colon &Amp; Rectum

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“…The technique was first described in human by the Barcelona team in 2015 after the initial animal and cadaveric experiences, with a first case series involving 16 cases 8 . Since then, we found in literature 5 single-case reports ,,,, , 4 further case series ranging from 8 to 18 cases 9,10,11,12 and three multicentric experiences, reporting partially overlapping cohorts of 97 13 , 62 and 100 14 cases. Described cases vary in indication from IBD to FAP.…”

Section: Discussionmentioning

confidence: 99%

Transanal Proctcolectomy and Ileal Pouch-anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre.

Capolupo

Carannante

Mascianà

et al. 2020

Preprint

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Background: Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily.The aim of this study is to analyze our initial experience of transanal IPAA (Ta-IPAA), considering postoperative complications and medium-term functional outcomes.Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since October 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration.Results: Until March 2019, 8 patients underwent Ta-IPAA. In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding. There were no cases of anastomotic leakage.Medium-term functional outcomes were determined prospectively by a validated questionnaire (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, restriction in work and social genitourinary and sexual functions were also investigated.Conclusions: In our experience, Ta-IPAA provided good short and medium-term functional results in UC.

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“…Given the limited evidence, other authors advocate against being dogmatic in the application of the transanal approach to all patients, specifically thin and female patients, as it is argued that there is no perceived advantage over a pouch created laparoscopically. 20 However, there is evolving evidence that the transanal approach may have some benefit in several postoperative outcomes. Short-term morbidity rates of Ta-IPAA were reported to be 33% compared with 41% in traditional abdominal IPAA in a retrospective cohort study, but these findings were not statistically significant.…”

Section: Potential Advantages Of Ta-ipaamentioning

confidence: 99%

Indications and Surgical Technique for Transanal Proctectomy and Ileal Pouch–Anal Anastomosis for Inflammatory Bowel Disease

Yuen

Brar

Overstraeten

2022

Clin Colon Rectal Surg

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Surgical management of inflammatory bowel disease has advanced significantly over the years. One particular focus of its evolution has been to minimize invasiveness. Transanal surgery has given the contemporary surgeon an alternate approach to access the low rectum situated in the confines of the deep pelvis. In benign disease, combining transanal surgery with laparoscopy has allowed for the development of novel techniques to create ileal pouch–anal anastomoses, perform intersphincteric Crohn's proctectomies, manage complications from pelvic surgery, and facilitate redo pelvic surgery. We aim to review the indications for transanal surgery in benign disease, describe an approach to transanal pouch surgery in detail, and discuss the potential benefits, pitfalls, and contentious issues surrounding this approach.

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Transanal completion proctectomy with close rectal dissection and ileal pouch‐anal anastomosis for ulcerative colitis

Abstract: Our initial experience with transanal completion proctectomy and ileal pouch-anal anastomosis shows promising results, demonstrating the feasibility of the transanal approach in patients with UC.

Cited by 14 publications

References 23 publications

Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques

Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques

Transanal Proctcolectomy and Ileal Pouch-anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre.

Indications and Surgical Technique for Transanal Proctectomy and Ileal Pouch–Anal Anastomosis for Inflammatory Bowel Disease

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