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

Aina Lask,Johann Pratschke,Luca Dittrich,Felix Aigner,Andreas Fischer,Safak Gül-Klein,Frank Tacke,Matthias Biebl,Sascha Chopra,Andreas Adler,Rosa Schmuck,Michael Knoop

doi:10.1186/s13037-021-00306-5

Abstract

BackgroundColectomy 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.MethodsWe 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.ResultsA 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.ConclusionPostoperative 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.

Highlights

Colectomy with transanal ileal pouch-anal anastomosis is a surgical technique that can be used to treat benign colorectal disease
Transanal total mesorectal excision was established for sphincter-preserving rectal resection due to rectal carcinoma, providing better access and overview especially in obese patients or male individuals with naturally narrow pelvises [6, 7]
To evaluate short- and long-term postoperative outcome, we only considered transanal ileal pouch-anal anastomosis (taIPAA) in patients with ulcerative colitis and excluded two patients

Summary

Introduction

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 pharmacological therapy has improved, colectomy rates reach up to 15%. Throughout the course of the disease, medical therapy refractory ulcerative colitis, which requires surgical treatment, leads to reconstructive surgery rates by restoring continuity of up to 15% [3]. In this regard, the use of minimally invasive ileal pouch-anal anastomosis (IPAA) is the favored technique [4, 5]. Anastomotic leakage in association to pouch complications might be of relevant impact for pouch failure after IPAA [9, 18]

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