Skip to main content

Advertisement

SpringerLink
Log in

The current state of the transanal approach to the ileal pouch-anal anastomosis

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The transanal approach to pelvic dissection has gained considerable traction and utilization continues to expand, fueled by the transanal total mesorectal excision (TaTME) for rectal cancer. The same principles and benefits of transanal pelvic dissection may apply to the transanal restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA)-the TaPouch procedure. Our goal was to review the literature to date on the development and current state of the TaPouch.

Materials and methods

We performed a PubMed database search for original articles on transanal pelvic dissections, IPAA, and the TaPouch procedure, with a manual search from relevant citations in the reference list. The main outcomes were the technical aspects of the TaPouch, clinical and functional outcomes, and potential advantages, drawbacks, and future direction for the procedure.

Results

The conduct of the procedure has been defined, with the safety and feasibility demonstrated in small series. The reported rates of conversion and anastomotic leakage are low. There are no randomized trials or large-scale comparative studies available for comparative effectiveness compared to the traditional IPAA.

Conclusions

The transanal approach to ileal pouch-anal anastomosis is an exciting adaption of the transanal total mesorectal excision for refining the technical steps of a complex operation. Additional experience is needed for comparative outcomes and defining the ideal training and implementation pathways.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222:120–127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 55:387–392

    Article  PubMed  Google Scholar 

  3. Baek SJ, Dozois EJ, Mathis KL, Lightner AL, Boostrom SY, Cima RR, Pemberton JH, Larson DW (2016) Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience. Tech Coloproctol 20(6):369–374

    Article  PubMed  Google Scholar 

  4. Lee-Kong S, Kiran RP (2016) Ongoing challenges and controversies in ulcerative colitis surgery. Expert Rev Gastroenterol Hepatol 10(2):187–191

    Article  CAS  PubMed  Google Scholar 

  5. Bartels SA, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA (2013) Systematic review and metaanalysis of laparoscopic versus open colectomy with end ileostomy for nontoxic colitis. Br J Surg 100:726–733

    Article  CAS  PubMed  Google Scholar 

  6. Fajardo AD, Dharmarajan S, George V, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2010) Laparoscopic versus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity. J Am Coll Surg 211:377–383

    Article  PubMed  Google Scholar 

  7. Oresland T, Bemelman WA, Sampietro GM, Spinelly A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, de Buck van Overstraeten A, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D’Hoore A, European Crohn’s and Colitis Organisation (ECCO) (2015) European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9:4–25

    Article  PubMed  Google Scholar 

  8. Row D, Weiser MR (2010) An update on laparoscopic resection for rectal cancer. Cancer Control 17(1):16–24

    Article  PubMed  Google Scholar 

  9. Young M, Pigazzi A (2014) Total mesorectal excision: open, laparoscopic or robotic. Recent Results Cancer Res 203:47–55

    Article  PubMed  Google Scholar 

  10. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  11. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  PubMed  Google Scholar 

  12. Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Arroyave MC, DeLacy FB, Lacy AM (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol 43:502–505

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, Darzi AW, Fazio VW, Nicholls RJ, Tekkis PP (2007) Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Dis 9(4):310–320

    Article  CAS  PubMed  Google Scholar 

  16. Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  17. de Buck van Overstraeten A, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM, Vanbrabant K, D’Hoore A, Bemelman WA, Tottrup A, Tanis PJ (2017) Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg 266(5):878–883

    Article  Google Scholar 

  18. Warusavitarne J, Gustavo Kotze P (2017) Double single-port transanal pouch surgery: a novel technique for rectal excision and ileo-anal pouch anastomosis for ulcerative colitis. J Coloproctol (Rio J) 37(4):328–331

    Article  Google Scholar 

  19. Coffey JC, Dillon MF, O’Driscoll JS, Faul E (2016) Transanal total mesocolic excision (taTME) as part of ileoanal pouch formation in ulcerative colitis—first report of a case. Int J Colorectal Dis 31:735–736

    Article  PubMed  Google Scholar 

  20. Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J (2016) Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis 18(12):1162–1166

    Article  CAS  PubMed  Google Scholar 

  21. 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–O144

    Article  Google Scholar 

  22. Carvello M, David G, Sacchi M, Di Candido F, Spinelli A (2018) Restorative proctocolectomy and ileal pouch-anal anastomosis for right-sided colonic adenocarcinoma in familial adenomatous polyposis: an abdominal laparoscopic approach combined with transanal total mesorectal excision—a video vignette. Colorectal Dis 20(4):355–356

    Article  CAS  PubMed  Google Scholar 

  23. Spinelli A, Cantore F, Kotze PG, David G, Sacchi M, Carvello M (2017) Fluorescence angiography during transanal trans-stomal proctectomy and ileal pouch anal anastomosis: a video vignette. Colorectal Dis. https://doi.org/10.1111/codi.13992

    Article  PubMed  Google Scholar 

  24. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685

    Article  PubMed  Google Scholar 

  25. Tasende MM, Delgado S, Jimenez M, Del Gobbo GD, Fernández-Hevia M, DeLacy B, Balust J, Lacy AM (2015) Minimal invasive surgery: NOSE and NOTES in ulcerative colitis. Surg Endosc 29(11):3313–3318

    Article  PubMed  Google Scholar 

  26. Bartels SA, Gardenbroek TJ, Aarts M, Ponsioen CY, Tanis PJ, Buskens CJ, Bemelman WA (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  PubMed  Google Scholar 

  27. Bracey E, Knol J, Buchs N, Jonez O, Cunningham C, Guy R, Mortensen N, Hompes R (2015) Technique for a stapled anastomosis following transanal total mesorectal excision for rectal cancer. Colorectal Dis 17:O208–O212

    Article  CAS  PubMed  Google Scholar 

  28. Vahdad MR, Rahmanian E, Moslemi S, Najafi SM, Foroutan HR (2015) Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J): an experimental study of a novel approach. Iran J Med Sci 40(5):425–429

    Google Scholar 

  29. Vahdad MR, Cernaianu G, Semaan A, Klein T, Faran S, Zemon H, Boemers T, Foroutan HR (2016) An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation. Surg Endosc 30(7):3107–3113

    Article  PubMed  Google Scholar 

  30. Ambe PC, Zirngibl H, Möslein G (2017) Initial experience with taTME in patients undergoing laparoscopic restorative proctocolectomy for familial adenomatous polyposis. Tech Coloproctol 21(12):971–974

    Article  CAS  PubMed  Google Scholar 

  31. Chen CC, Lai YL, Jiang JK, Chu CH, Huang IP, Chen WS, Cheng AY, Yang SH (2016) Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol 23:1169–1176

    Article  PubMed  Google Scholar 

  32. Kneist W, Hanke L, Kauf DW, Lang H (2016) Surgeons’ assessment of internal anal sphincter nerve supply during TaTME—inbetween expectations and reality. Minim Invasive Ther 25:241–246

    Article  Google Scholar 

  33. Borstlap WA, Harran N, Tanis PJ, Bemelman WA (2016) Feasibility of the TAMIS technique for redo pelvic surgery. Surg Endosc 30(12):5364–5371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Roumen RM, Rahusen FT, Wijnen MH, Croiset van Uchelen FA (2000) “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum 43:522–525

    Article  CAS  PubMed  Google Scholar 

  35. Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C (2015) Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc 29:3319–3323

    Article  PubMed  Google Scholar 

  36. Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 41:478–483

    Article  CAS  PubMed  Google Scholar 

  37. Burke JP, Martin-Perez B, Khan A, Nassif G, de Beche-Adams T, Larach SW, Albert MR, Atallah S (2016) Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 18:570–577

    Article  CAS  PubMed  Google Scholar 

  38. Buchs NC, Nicholson GA, Ris F, Mortensen NJ, Hompes R (2015) Transanal total mesorectal excision: a valid option for rectal cancer? World J Gastroenterol 21:11700–11708

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  40. Koedam TWA, van Ramshorst GH, Deijen CL et al (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21(1):25–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Atallah S, Hodges A, Larach SW (2018) Direct target NOTES: prospective applications for next generation robotic platforms. Tech Coloproctol 22(5):363–371

    Article  CAS  PubMed  Google Scholar 

  42. Keller DS, Joshi HM, Rodriguez-Justo M, Walsh D, Coffey JC, Chand M (2017) Using fluorescence lymphangiography to define the ileocolic mesentery: proof of concept for the watershed area using real-time imaging. Tech Coloproctol 21:757–760

    Article  CAS  PubMed  Google Scholar 

  43. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA et al (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220:82–92.e1

    Article  PubMed  Google Scholar 

  44. Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P et al (2018) IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 20:O226–O234

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Adamina M, Buchs NC, Penna M, Hompes R, St.Gallen CCEG (2018) St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 32:1091–1103

    Article  PubMed  Google Scholar 

  46. Francis N, Penna M, Mackenzie H, Carter F, Hompes R, International, TaTME Educational Collaborative Group (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 31:2711–2719

    Article  PubMed  Google Scholar 

  47. Knol J, Keller DS (2018) Cognitive skills training in digital era: a paradigm shift in surgical education using the TaTME model. Surgeon. https://doi.org/10.1016/j.surge.2018.03.008

    Article  PubMed  Google Scholar 

  48. Penna M, Hompes R, Mackenzie H, Carter F, Francis NK (2016) First international training and assessment consensus workshop on transanal total mesorectal excision (taTME). Tech Coloproctol 06:20:343–352

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain

    F. Borja de Lacy, Beatriz Martin-Perez & Antonio M. Lacy

  2. Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, New York, NY, USA

    Deborah Susan Keller

  3. General Surgery Department, Mansoura Faculty of Medicine, Mansoura, Egypt

    Sameh Hany Emile

  4. Department of Gastroenterological Intervention, University College London, City of London, UK

    Manish Chand

  5. Division Colon and Rectal Surgery, Humanitas Research Hospital, Humanitas University Rozzano Milano, Milano, Italy

    Antonino Spinelli

Authors
  1. F. Borja de Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Susan Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beatriz Martin-Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sameh Hany Emile
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manish Chand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonino Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio M. Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Borja de Lacy.

Ethics declarations

Disclosures

Professor Spinelli reports teaching and consulting honoraria from Applied Medical and Ethicon outside of this work. Mr. Chand reports teaching, consulting, and personal fees from Ethicon and Stryker outside of the submitted work. Professor Lacy reports Grants from Medtronic and Olympus, and personal fees from Applied Medical and Conmed, outside the submitted work. Dr. de Lacy, Dr. Keller, Dr. Emile, and Dr. Martin-Perez have no conflicts of interest or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Lacy, F.B., Keller, D.S., Martin-Perez, B. et al. The current state of the transanal approach to the ileal pouch-anal anastomosis. Surg Endosc 33, 1368–1375 (2019). https://doi.org/10.1007/s00464-019-06674-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06674-5

Keywords

Search

Navigation