P167 Functional outcomes of transanal versus transabdominal proctectomy with ileal pouch-anal anastomosis in Ulcerative Colitis. A comparative study

Abstract

Abstract Background This study aimed at comparing functional outcomes and quality of life (QoL) after transanal and transabdominal approach for ileal-pouch surgery in ulcerative colitis (UC)Ileal-pouch surgery ensures satisfactory intestinal function and QoL. The transanal ileal pouch-anal anastomisis (Ta-IPAA) has recently been developed in the effort to address the technical shortfalls of the traditional transabdominal approach (Tabd-IPAA). According to previous studies, Ta-IPAA is safe. However, functional outcomes after ta-IPAA are scarcely described. Methods This is a retrospective study of consecutive UC patients who underwent IPAA from 2011 to 2017. Only patients operated according to a modified-2 or 3 stage approach were included in the analysis. Close rectal dissection was systematically performed in Ta-IPAA as opposed to total mesorectal excision in Tabd-IPAA. Groups were compared after propensity score weighting. Functional outcomes were assessed using two functional scoring systems: the Pouch Functional Score (PFS) and the Öresland score (OS). The global quality of life scale (GQOL) was used for patients’ overall perspective on QoL. Follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Results One hundred and nine patients were included. Of them, 38 patients underwent 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=0.02 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 score for Ta-IPAA was 82.7 (CI 75.1–90.2) vs 75.5 (69.4–81.6) for Tabd-IPAA (p=0.038). Conclusion Transanal IPAA provides better functional results and QoL scores than Tabd-IPAA in UC patients.