Functional Outcomes Following Laparoscopic Ileal Pouch-Anal Anastomosis in Patients with Chronic Ulcerative Colitis: Long-Term Follow-up of a Case-Matched Study
- 338 Downloads
Laparoscopic ileal pouch-anal anastomosis (L-IPAA) has been increasingly adopted over the last decade due to short-term patient-related benefits. Several studies have shown L-IPAA to be equivalent to open IPAA in terms of safety and short-term outcomes. However, few L-IPAA studies have examined long-term functional outcomes. We aimed to evaluate the long-term functional outcomes of L-IPAA as compared to open IPAA.
A previous case-matched cohort study at our institution compared short-term outcomes between L-IPAA and open IPAA from 1998 to 2004. For this study, we selected all patients from this case-matched cohort study with chronic ulcerative colitis (CUC) who had follow-up functional data of greater than 1 year. Functional data was obtained through prospective surveys, which were sent annually to all IPAA patients postoperatively.
One hundred and forty-nine patients (58 L-IPAA, 91 open IPAA) with a median 8-year duration of follow-up were identified. There were no differences in demographics and long-term surgical outcomes between groups. Stapled anastomosis was more common in the laparoscopic group (91.4 versus 54.9%, p < 0.001). Stool frequency during daytime (>6 stools, L-IPAA 32.8%, open 49.4%, p = 0.048) and nighttime (>2 stools, L-IPAA 13.8%, open 30.6%; p = 0.024) was significantly lower in the L-IPAA group. Ability to differentiate gas from stool was not different (p = 0.13). Rate of complete continence was similar in L-IPAA and open groups (L-IPAA 36.2%, open 21.8%, p = 0.060). There was no difference in use of medication to control stools, perianal skin irritation, voiding difficulty, sexual problems, and occupational change between groups. Subgroup analysis to evaluate for any group differences attributable to anastomotic technique demonstrated only that stapled anastomoses lead to more perianal skin irritation in the L-IPAA group (L-IPAA = 60.4% versus open IPAA = 38.8%; p = 0.031).
Overall, L-IPAA has comparable functional results to the open approach with slightly lower daytime and nighttime stool frequency. This difference may be attributed to a greater number of stapled anastomoses performed in the laparoscopic cohort.
KeywordsLaparoscopy Ileal pouch-anal anastomosis (IPAA) Long-term Follow-up Functional outcomes
All authors listed meet all four criteria for authorship.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Pandey S, Luther G, Umanskiy K, et al. Minimally invasive pouch surgery for ulcerative colitis: is there a benefit in staging? Dis Colon Rectum. 2011;54(3):306–310.Google Scholar
- 6.Fleming FJ, Francone TD, Kim MJ, Gunzler D, Messing S, Monson JR. A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis. Dis Colon Rectum. 2011;54(2):176–182.Google Scholar
- 10.Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum. 2001;44(12):1800–1807.Google Scholar
- 15.Foley EF, Schoetz DJ, Jr., Roberts PL, et al. Rediversion after ileal pouch-anal anastomosis: causes of failures and predictors of subsequent pouch salvage. Dis Colon Rectum. 1995;38(8):793–798.Google Scholar
- 17.MacRae HM, McLeod RS, Cohen Z, O’Connor BI, Ton EN. Risk factors for pelvic pouch failure. Dis Colon Rectum. 1997;40(3):257–262.Google Scholar
- 20.Remzi FH, Church JM, Bast J, et al. Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum. 2001;44(11):1590–1596.Google Scholar