Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis - A Retrospective Single-Center Study Regarding Anastomotic Leakage and Episodes of Pouchitis in the Long-Term

Abstract Introduction:Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis (UC) is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. Objective of this study was to determine anastomotic leakage (AL) rates and treatment after taIPAA as well as short- and long-term pouch function. Patients and Methods:Data from a prospectively collected database of all patients undergoing taIPAA in our center between March 2015 and August 2019 was analyzed retrospectively. Patients with indications other than UC or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded. Results:Of 23 patients undergoing taIPAA in our center 20 patients met the inclusion criteria, with a median age of 36 years at the time of pouch formation. Overall prevalence of AL was 10% with one early (11 days after operation) and one late AL (19 months after operation). In both patients pouches could be preserved with a multimodal approach based on endosponge therapy. Data on short-term pouch function could be obtained in 11 (55.8%) patients and was satisfactory in all cases. In the long-term we observed a pouchitis rate of 57.9% and a pouch failure rate of 5.3%.Conclusion:In our study, taIPAA surgery is a safe procedure and results in good patient outcome. The rate of AL is comparable to transabdominal IPAA. In order to fully evaluate the risks and benefits of taIPAA further studies with larger cohorts of patients are required.

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Safety of transanal ileal pouch-anal anastomosis for ulcerative colitis: a retrospective observational cohort study

Patient Safety in Surgery ◽

10.1186/s13037-021-00306-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Aina Lask ◽

Matthias Biebl ◽

Luca Dittrich ◽

Andreas Fischer ◽

Andreas Adler ◽

...

Keyword(s):

Ulcerative Colitis ◽

Anastomotic Leakage ◽

Ileal Pouch ◽

Colorectal Disease ◽

Pouch Function ◽

Long Term Follow Up ◽

Benign Colorectal Disease ◽

Short And Long Term

Abstract Background Colectomy with transanal ileal pouch-anal anastomosis (taIPAA) is a surgical technique that can be used to treat benign colorectal disease. Ulcerative colitis is the most frequent inflammatory bowel disease (IBD) and although pharmacological therapy has improved, colectomy rates reach up to 15%. The objective of this study was to determine anastomotic leakage rates and treatment after taIPAA as well as short- and long-term pouch function. Methods We conducted a retrospective analysis of a prospective database of all patients undergoing taIPAA at an academic tertiary referral center in Germany, between 01/03/2015 and 31/08/2019. Patients with indications other than ulcerative colitis or with adjuvant chemotherapy following colectomy for colorectal carcinoma were excluded for short- and long-term follow up due to diverging postoperative care yet considered for evaluation of anastomotic leakage. Results A total of 22 patients undergoing taIPAA during the study time-window were included in analysis. Median age at the time of surgery was 32 ± 12.5 (14–54) years. Two patients developed an anastomotic leakage at 11 days (early anastomotic leakage) and 9 months (late anastomotic leakage) after surgery, respectively. In both patients, pouches could be preserved with a multimodal approach. Twenty patients out of 22 met the inclusion criteria for short and long term follow-up. Data on short-term pouch function could be obtained in 14 patients and showed satisfactory pouch function with only four patients reporting intermittent incontinence at a median stool frequency of 9–10 times per day. In the long-term we observed an inflammation or “pouchitis” in 11 patients and a pouch failure in one patient. Conclusion Postoperative complication rates in patients with benign colorectal disease remain an area of concern for surgical patient safety. In this pilot study on 22 selected patients, taIPAA was associated with two patients developing anastomotic leakage. Future large-scale validation studies are required to determine the safety and feasibility of taIPAA in patients with ulcerative colitis.

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Pregnancy Delivery and Pouch Function After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Diseases of the Colon & Rectum ◽

10.1007/s10350-004-6730-y ◽

2003 ◽

Vol 46 (9) ◽

pp. 1292 ◽

Cited By ~ 11

Author(s):

Thanesan Ramalingam ◽

Benjamin Box ◽

Neil McC v

Keyword(s):

Ulcerative Colitis ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Pouch Function ◽

Anal Anastomosis

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Long-term outcomes following restorative proctocolectomy ileal pouch-anal anastomosis in pediatric ulcerative colitis patients: Multicenter national study in Japan

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12198 ◽

2018 ◽

Vol 2 (6) ◽

pp. 428-433 ◽

Cited By ~ 1

Author(s):

Hiroki Ikeuchi ◽

Motoi Uchino ◽

Akira Sugita ◽

Kitaro Futami ◽

Kouhei Fukushima ◽

...

Keyword(s):

Ulcerative Colitis ◽

Restorative Proctocolectomy ◽

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

National Study ◽

Long Term Outcomes ◽

Anal Anastomosis

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz174 ◽

2019 ◽

Vol 14 (6) ◽

pp. 726-733 ◽

Cited By ~ 3

Author(s):

Pramodh Chandrasinghe ◽

Michele Carvello ◽

Karin Wasmann ◽

Caterina Foppa ◽

Pieter Tanis ◽

...

Keyword(s):

Quality Of Life ◽

Ulcerative Colitis ◽

Functional Outcomes ◽

Ileal Pouch ◽

Cohort Analysis ◽

Ileal Pouch Anal Anastomosis ◽

Global Quality Of Life ◽

Anal Anastomosis

Abstract Background 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. Methods 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. Results 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 [>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]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.

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