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A prospective analysis of the postoperative and long-term functional outcomes of a novel technique to perform rectal transection during laparoscopic restorative proctectomy and ileal pouch–anal anastomosis

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Abstract

Background

Laparoscopic ileal pouch–anal anastomosis (IPAA) technique is not standardized. An irregular division of the rectum could result in poor functional outcomes and residual diseased mucosa. The aim of the study was to develop a new technique for performing the rectal transection via a laparoscopic approach, and to compare the outcomes of this technique with those of the open surgery IPAA.

Methods

This prospective study included all patients who underwent restorative proctectomy (following a previous subtotal colectomy) for ulcerative colitis in October 2017–November 2020. Rectal division was performed using a 30 mm open linear stapler which was applied laparoscopically across the distal rectum. Postoperative and functional outcomes, length of anal stump and completeness of mucosal removal were compared. Only the patients who had their ileostomy reversed by 31 December 2020 and, therefore, a minimum follow-up of 6 months from the ileostomy closure, were included in the analysis of the functional outcomes and quality of life.

Results

There were 207 patients (161 laparoscopic, 46 open). Median age was 43 (18–77) years and 85 patients (41.1%) were male. Major complications (9.3 vs. 8.7%, p = 0.89) including anastomotic leaks (3.7 vs 4.4%, p = 0.84) were similar after laparoscopic and open IPAA. Patients reported a comparable number of bowel movements during the day (6 vs. 7, p = 0.21) and at night (2 vs. 2, p = 0.66), and a similar rate of episodes of incontinence during the previous 6 months (3.7 vs. 4.3%, p = 0.75). The mean Cleveland Global Quality of Life score was also similar (0.79 vs. 0.74, p = 0.35).

Conclusion

Our technique is safe and reproducible, and replicates the results of the open IPAA, while maintaining the advantages of minimally invasive surgery and avoiding any kind of anal manipulation which could result in poor long-term functional outcomes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funds were received for the present study.

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Authors and Affiliations

  1. Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Gilberto Poggioli, Matteo Rottoli, Angela Romano, Massimo P. Di Simone, Luca Boschi & Lorenzo Gentilini

  2. Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Gilberto Poggioli, Matteo Rottoli & Massimo P. Di Simone

Authors
  1. Gilberto Poggioli
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  2. Matteo Rottoli
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  3. Angela Romano
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  4. Massimo P. Di Simone
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  5. Luca Boschi
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  6. Lorenzo Gentilini
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Corresponding author

Correspondence to Matteo Rottoli.

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The authors report no conflicts of interest.

Ethical approval

The present study was approved by the Institutional Ethical Committee (Area Vasta Emilia Centro) and was performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Poggioli, G., Rottoli, M., Romano, A. et al. A prospective analysis of the postoperative and long-term functional outcomes of a novel technique to perform rectal transection during laparoscopic restorative proctectomy and ileal pouch–anal anastomosis. Tech Coloproctol 26, 583–590 (2022). https://doi.org/10.1007/s10151-022-02611-2

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  • DOI: https://doi.org/10.1007/s10151-022-02611-2

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