Laparoscopic Versus Transanal Ileal-Pouch Anal Anastomosis for Ulcerative Colitis: A Patient-Centered Treatment Trade-Off Study.

Abstract

Transanal ileal pouch anal anastomosis is a relatively new technique aiming to reduce surgical invasiveness while providing better access to the pelvis in patients with ulcerative colitis. Currently, patients' preference on surgical approach has never been investigated. To observe patient preference between transanal and laparoscopic ileal pouch anal anastomosis by measuring the potential risk, expressed in pouch function reduction, patients are willing to take to undergo transanal surgery. We conducted standardized interviews of patients using the threshold technique. Patients from Mount Sinai Hospital in Toronto were included. Fifty-two patients with ulcerative colitis participated in this study. Patients with ulcerative colitis, with or without previous pouch surgery were submitted to standardized interviews using the threshold technique. We measured the absolute increase in bowel frequency, bowel urgency, and fecal incontinence patients would accept if undergoing transanal ileal pouch anal-anastomosis. Thirty-two patients (mean age: 38.7 ± 15.3) with previous surgery and 20 patients (mean age: 39.5 ± 11.9) with no previous surgery participated in this study. Patients accepted an absolute increase of 2 bowel movements per day and one episode of fecal incontinence per month to undergo transanal ileal pouch anal anastomosis. They also accepted 10 minutes of worsening bowel urgency (ie. decrease 10 minutes of "holding time") for transanal surgery. Younger patients aged 21-29 only accepted an absolute decrease of 5 minutes in "holding time" (P = 0.02). Biases inherent to study design. Patients were willing to accept a potential reduction in pouch function to receive the less invasive method of transanal ileal pouch anal anastomosis. More studies evaluating long-term functional outcomes after transanal ileal pouch anal anastomosis are required to help patients make educated surgical decisions..