Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [&amp;gt;10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.</jats:p> </jats:sec>

Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital

“…The limitations of this study are mainly related to its retrospective design, the absence of a control group and the lack of functional results. However, a recent multicentre study has stated that Ta‐IPAA has comparable long‐term functional outcomes compared to the transabdominal approach [48].…”

Transanal Proctocolectomy And Ileal Pouch-Anal Anastomosis (TaIPAA) For Ulcerative Colitis: Medium Term Functional Outcomes In A Single Centre.

“…A more recent paper 14 reported a multicentric experience evaluating the long-term outcomes of Ta-IPAA against Abd-IPAA in restorative proctocolectomy, in 100 vs 274 cases. It shows that there are no statistically signi cant differences between Ta-IPAA and Trans-abdominal-IPAA considering quality of life and that Ta-IPAA is associated with higher quality of health and energy level.…”

“…The transanal approach for the proctectomy has been described also in IPAA since 2015, showing feasibility and potential technical advantages 8 ; some series 9,10,11,12 and initial comparative studies have been published 13,14 , showing a similar rate of postoperative morbidity, equivalent quality of life and functional results. The complete mesorectal excision is not requested for this indication, and is rarely performed in the described experiences.…”

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

“…A more recent paper 14 reported a multicentric experience evaluating the long-term outcomes of Ta-IPAA against Abd-IPAA in restorative proctocolectomy, in 100 vs 274 cases. It shows that there are no statistically significant differences between Ta-IPAA and Abd-IPAA considering quality of life and that Ta-IPAA is associated with higher quality of health and energy level.…”