Early postoperative complications after stapled vs handsewn restorative proctocolectomy with ileal pouch‐anal anastomosis in 148 patients with familial adenomatous polyposis coli: a matched‐pair analysis

Abstract

Restorative proctocolectomy with ileal pouch-anal anastomosis for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) has been modified from a transanal hand-suture after mucosectomy to a stapled ileal pouch-anal anastomosis (IPAA) without mucosectomy. Better functional results favour stapled anastomosis; however, stapled anastomosis results in higher rates of adenomas in persisting anorectal mucosa. The purpose of this study was to compare the two techniques of pouch-anal anastomosis with respect to early postoperative complications in a collective of FAP patients. The study was performed as a matched-pair analysis. Data were obtained from a prospectively collected database. The overall rate of postoperative complications was higher after stapled IPAA (31% stapled vs 23% handsewn), with anastomotic stricture occurring in 24.3% (stapled) and 16.2% (handsewn) (P=0.22). Any leakage or pelvic abscess formation after stapled anastomosis occurred within 30days in almost all patients, whereas these were mainly diagnosed between 30days and 6months after handsewn IPAA. A laparoscopic approach was used in 56.7% of patients in the stapled group but in only two patients in the handsewn group. Intra-operative blood loss was significantly higher in the handsewn group (mean±SD: 699±511ml vs 369±343ml; P<0.0001), as was the volume of blood transfused (mean±SD: 205±365ml vs 8±49ml; P< 0.0001). Function did not differ between the groups. There was a nonstatistically significant tendency towards a higher rate of early postoperative complications after stapled IPAA. The timing of anastomotic leakage and abscess formation differed between the groups.