Abstract
BackgroundTransanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.MethodsOur Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.ResultsUntil March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.ConclusionsIn our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.
Highlights
Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC) showing promising results
Restorative proctocolectomy is widely adopted in the treatment of ulcerative colitis (UC) [1,2,3] as well as in other inflammatory and neoplastic conditions, requiring
Quality of life was evaluated at 6 mo. after ileostomy closure according to Fazio et al [20], using both the validated Cleveland Global Quality of Life (CGQL) questionnaire, and the happiness with surgery
Summary
Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes. Transanal total mesorectal excision (TaTME) has been recently described in rectal cancer treatment [6], with potential technical and oncologic advantages compared to transabdominal approach [7], especially in man. The transanal approach for the proctectomy has been described in IPAA since 2015 [8], showing feasibility and potential technical advantages; some series [9,10,11,12] and initial comparative studies have been published [13, 14], showing a similar rate of postoperative morbidity, equivalent quality of life and functional results. The complete mesorectal excision is not required for this indication and is rarely performed in the described experiences
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