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Functional outcomes of transanal versus transabdominal restorative proctectomy with ileal pouch-anal anastomosis in ulcerative colitis—a monocentric retrospective comparative study

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Abstract

Background

Ileal pouch-anal anastomosis (IPAA) ensures satisfactory gastro-intestinal function and quality of life (QoL) in patients with refractory ulcerative colitis (UC). The transanal approach to proctectomy and IPAA (Ta-IPAA) has been developed to address the technical shortfalls of the traditional transabdominal approach (Tabd-IPAA). Ta-IPAA has proven to be safe but there is lack of reported functional outcomes. Aim of this study is to compare functional outcomes and QoL after Ta- or Tabd-IPAA for UC.

Methods

This is a retrospective study of consecutive UC patients who underwent IPAA between 2011 and 2017, operated according to a modified 2- or 3-stage approach. Close rectal dissection was performed in Ta-IPAA as opposed to total mesorectal excision in Tabd-IPAA. A propensity score weighting was performed. Functional outcomes were assessed using the pouch functional score (PFS) and the Öresland score (OS). The global quality of life scale (GQOL) was used for patients’ perspective on QoL. Follow-up was scheduled at 1, 3, 6, and 12 months, postoperatively.

Results

One hundred and eight patients were included: 38 patients had Ta-IPAA. At 12 months follow-up, mean OS and PFS were 4.6 (CI 3.2–6.0) vs 6.2 (CI 5.0–7.3), p = 0.025 and 6.1 (CI 3.5–8.8) vs 7.4 (CI 5.4–9.5), p = 0.32, for Ta and Tabd-IPAA, respectively. Mean GQOL for Ta-IPAA was 82.5 (CI 74.8–90.1) vs 75.5 (69.4–81.7) for Tabd-IPAA (p = 0.045).

Conclusions

At 12 months postoperatively, pouch function and QoL of Ta-IPAA are probably as good as those of Tabd-IPAA. Limitations include retrospectivity, differences in the surgical technique, and lack of validated scores for QoL.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88

    Article  CAS  Google Scholar 

  2. Carne PW, Pemberton JH (2004) Technical aspects of ileoanal pouch surgery. Clin Colon Rectal Surg 17(1):35–41

    Article  Google Scholar 

  3. de Buck van Overstraeten A, Wolthuis AM, D'Hoore A (2016) Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique. Colorectal Dis 18(4):O141–4

  4. de Buck van Overstraeten A, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM et al (2017) Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg 266(5):878–83

  5. Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98(11):1635–1643

    Article  CAS  Google Scholar 

  6. Valsdottir EB, Yarandi SS, Marks JH, Marks GJ (2014) Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions. Surg Endosc 28(1):193–202

    Article  Google Scholar 

  7. Hompes R, Ashraf SQ, Gosselink MP, van Dongen KW, Mortensen NJ, Lindsey I et al (2015) Evaluation of quality of life and function at 1 year after transanal endoscopic microsurgery. Colorectal Dis 17(2):O54-61

    Article  CAS  Google Scholar 

  8. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685

    Article  Google Scholar 

  9. Lovegrove RE, Fazio VW, Remzi FH, Tilney HS, Nicholls RJ, Tekkis PP (2010) Development of a pouch functional score following restorative proctocolectomy. Br J Surg 97(6):945–51

    Article  CAS  Google Scholar 

  10. Oresland T, Fasth S, Nordgren S, Hulten L (1989) The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorectal Dis 4(1):50–6

    Article  CAS  Google Scholar 

  11. Hyland ME, Sodergren SC (1996) Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Qual Life Res 5(5):469–480

    Article  CAS  Google Scholar 

  12. Rosenbaum PRRDB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55

    Article  Google Scholar 

  13. Curtis LH. HBG, Eisenstein EL et al (2007) Using inverse probability weighted estimators in comparative effectiveness analyses with observational databases. Med Care 2007;45(10 suppl 2):S103–S107

  14. Mora Lopez L, Serra Aracil X, Hermoso Bosch J, Rebasa P, Navarro SS (2015) Study of anorectal function after transanal endoscopic surgery. Int J Surg 13:142–147

    Article  CAS  Google Scholar 

  15. Kirkegaard P, Bulow S, Olsen PS, Gyrtrup HJ (1990) The first year with a J-pouch. A prospective evaluation. Int J Colorectal Dis 5(3):148–50

    Article  CAS  Google Scholar 

  16. Chandrasinghe P, Carvello M, Wasmann K, Foppa C, Tanis P, Perry-Woodford Z et al (2020) Transanal ileal pouch-anal anastomosis for ulcerative colitis has comparable long-term functional outcomes to transabdominal approach: a multicentre comparative study. J Crohns Colitis 14(6):726–733

    Article  Google Scholar 

  17. de Buck van Overstraeten A, Wolthuis AM, Vermeire S, Van Assche G, Laenen A, Ferrante M et al (2014) Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. J Crohns Colitis 8(10):1261–6

  18. van Balkom KA, Beld MP, Visschers RG, van Gemert WG, Breukink SO (2012) Long-term results after restorative proctocolectomy with ileal pouch-anal anastomosis at a young age. Dis Colon Rectum 55(9):939–947

    Article  Google Scholar 

  19. Kiran RP, El-Gazzaz G, Remzi FH, Church JM, Lavery IC, Hammel J et al (2011) Influence of age at ileoanal pouch creation on long-term changes in functional outcomes. Colorectal Dis 13(2):184–190

    Article  CAS  Google Scholar 

  20. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218

    Article  Google Scholar 

  21. de Lacy FB, Keller DS, Martin-Perez B, Emile SH, Chand M, Spinelli A et al (2019) The current state of the transanal approach to the ileal pouch-anal anastomosis. Surg Endosc 33(5):1368–1375

    Article  Google Scholar 

  22. Aydinli HH, Esen E, Aytac E, Kirat HT, Schwartzberg DM, Chang S et al (2020) Transabdominal pouch salvage for failed minimally invasive versus open IPAA: a case-matched study. Dis Colon Rectum 63(8):1102–1107

    Article  Google Scholar 

  23. Bartels SA, Gardenbroek TJ, Aarts M, Ponsioen CY, Tanis PJ, Buskens CJ et al (2015) Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis. Br J Surg 102(3):281–287

    Article  CAS  Google Scholar 

  24. de Groof EJ, van der Meer JHM, Tanis PJ, de Bruyn JR, van Ruler O, D’Haens G et al (2019) Persistent mesorectal inflammatory activity is associated with complications after proctectomy in Crohn’s disease. J Crohns Colitis 13(3):285–293

    Article  Google Scholar 

  25. Spinelli A, Foppa C, Carvello M, Sacchi M, De Lucia F, Clerico G et al (2021) Transanal transection and single-stapled anastomosis (TTSS): a comparison of anastomotic leak rates with the double-stapled technique and with transanal total mesorectal excision (TaTME) for rectal cancer. Eur J Surg Oncol 47(12):3123–3129

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospitals Leuven, KU, Leuven, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Gabriele Bislenghi, Melvin Denolf, Albert Wolthuis & André D’Hoore

  2. KU Leuven – University of Leuven, I-BioStat, B-3000, Leuven, Belgium

    Steffen Fieuws

Authors
  1. Gabriele Bislenghi
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  2. Melvin Denolf
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  3. Steffen Fieuws
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  4. Albert Wolthuis
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  5. André D’Hoore
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Contributions

Gabriele Bislenghi conceived, set up, gave interpretation to results, and write down the study. Melvin Denolf retrieved data from the patients chart and fill in the database. Steffen Fieuws is responsible for the statistical analysis. Albert Wolthuis and André D’Hoore gave important insights in the conception of the study as well as in the interpretation and revision of the manuscript.

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Correspondence to Gabriele Bislenghi.

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Bislenghi, G., Denolf, M., Fieuws, S. et al. Functional outcomes of transanal versus transabdominal restorative proctectomy with ileal pouch-anal anastomosis in ulcerative colitis—a monocentric retrospective comparative study. Langenbecks Arch Surg 407, 3607–3614 (2022). https://doi.org/10.1007/s00423-022-02640-3

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  • DOI: https://doi.org/10.1007/s00423-022-02640-3

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