Anastomosis For Ulcerative Colitis Research Articles

The impact of colectomy and restorative procedure on pouch function after ileo-pouch-anal anastomosis in ulcerative colitis. The icon fun study on behalf of the Italian Society of Colon and Rectal Surgery (SICCR) Inflammatory Bowel Diseases committee

BackgroundAvailable guidelines lack in indications on surgical standard in Ulcerative Colitis (UC) AimsTo determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. The secondary aims consisted of perioperative outcomes and complications. MethodsData on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological Low-Anterior-Resection-Syndrome (LARS) score. ResultsMesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. Laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). Mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). Hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). The Transanal-Transection and Single-Stapling Anastomosis (TTSS) showed to be protective against pouchitis. Extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057). ConclusionsThe study highlights advantages of laparoscopy. New techniques such as TTSS promise further improvements. Mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.

Ileorectal anastomosis in ulcerative colitis: what do surgeons and patients need to know? A systematic literature review.

Ileal pouch-anal anastomosis (IPAA) is currently the gold standard for restoration of gastrointestinal continuity after colectomy for ulcerative colitis in the UK. However, with further experience of the risks relating to IPAA, the use of ileorectal anastomosis (IRA) is being revisited. Decisions regarding restorative surgery after colectomy are individual to every patient's circumstances, and this paper aims to provide a comprehensive review of the literature to guide a full discussion of the risks and benefits of IRA. A systematic literature review was conducted of papers published from 2000 onwards relating to IRA and ulcerative colitis, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The papers were reviewed by two independent surgeons for information it was felt that patients and surgeons would want to know about the operation (cancer risk, bowel function, sexual and urinary function, fecundity/fertility and postoperative complications). Seventeen papers were identified for inclusion as they reported original data on one or more of the categories identified for discussion. The median ten-year cancer risk after IRA was 2.8% and the median failure rate at ten years was 21%. IRA was generally found to have lower postoperative complication rates and better bowel function than IRA, with sexual function similar and fecundity not commented on in any paper. For some patients, IRA can offer restorative surgery in the short or long term, with acceptable cancer risk, failure rate and postoperative complications, while avoiding the higher risks associated with IPAA.

P988 Preliminary report on short-term post-operative outcomes of robotic versus laparoscopic approach for restorative procto-colectomy with ileal-pouch-anal anastomosis in ulcerative colitis: a comparative study

Abstract Background Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) performed in two or three stages has become the standard surgical treatment in patients with ulcerative colitis (UC) in which the medical management fails. It is a technically complex operation associated with significant morbidity that can be performed with a laparoscopic or robotic approach. Robotic colorectal surgery is gaining popularity because it overcomes many of the mechanical and optical disadvantages of laparoscopy, although limited data are available regarding its safety, efficacy, and costs. This study compares the postoperative short-terms surgical outcomes of the two surgical approaches. Methods Robotic and laparoscopic restorative proctocolectomy procedures with IPAA consecutively performed between June 2015 and May 2023 were retrospectively collected. Inclusion criteria was UC not responders to medical therapy. Exclusion criteria was conversion to open surgery. Primary analyzed outcome were complications rate in the first month (30 days) according to Clavien Dindo Score and length of hospital stay (days). Statistical analysis was performed with a dedicated software (SPSS). Results A total of 54 patients with UC refractory to medical therapy were included, with 31 laparoscopic procedure and 23 robotic procedures. Demographic data were comparable between two groups in terms of age (48.7 vs 45.7 years; p= 0.62), BMI (22,0 vs 23,7 Kg/m2; p= 1.311) and ASA score (p=0,72).Short-term complications defined as Clavien Dindo scores 2-3, (compared with score 1) were 13% in the robotic group and 31% in the laparoscopic group (RR= 0.27, 95% conf. interv. 0.11-1.06). In particular, no high-grade Clavien-Dindo complications occurred in the robotic group while 3 events (grade 3) occurred in the laparoscopic group. No surgical reintervention was needed in both groups. Length of hospital stay was a mean of 7.3 days in lap-group and 6.3 days in rob-group with no statistical significativity (p=0,09). Conclusion This preliminary study concludes that robot-assisted surgery allows a reduction of short-term complications compared to laparoscopic approach. Moreover, robotic surgery allows a reduction of length of hospital stay although not statistically significant. Limits of the study were the retrospective design and the low numerosity of the sample, although comparable with the experiences already published.

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Association of ileocolic pedicle division with postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis

BackgroundWhen performing a restorative proctocolectomy (RPC) with an ileal pouch-anal anastomosis (IPAA), it is common practice to divide the ileocolic artery (ICA) if the patient has a tumor or dysplasia, or in order to gain sufficient length to secure a tension-free anastomosis. However, it is unclear whether there is an association between division of the ICA and the rate of postoperative complications.MethodsWe retrospectively analysed all patients with ulcerative colitis who underwent RPC and IPAA in our department between January 2010 and December 2016. These were divided in two groups, with regard to the ICA being preserved (PRE group) or divided (DIV group). Complications such as stenosis or leakage of the IPAA, perianal fistulas, abscess formation within the lesser pelvis and pouchitis were analysed and compared between both groups.ResultsWe identified 130 patients meeting the study inclusion criteria, 49 patients in the PRE and 81 patients in the DIV group. No statistical significance was observed in IPAA leakages (p = 0.71), anastomotic strictures (p = 0.33), fistulas (p = 0.19) and pouchitis (p = 0.72). Abscess formation frequency was similar in both groups (p > 0.99). Moreover, short-term (p = 0.53) and long-term complications (p = 0.11) were similar in both groups. A higher conversion rate was observed in obese (p = 0.006) and male (p = 0.02) patients. Within the entire study population, fistulas and IPAA leakages were associated with a higher rate of anastomotic strictures (p = 0.008 and p = 0.02 respectively).ConclusionOur data suggest similar IPAA related complications after either division or preservation of the ICA. Further trials are required in order to examine the trends observed in this study.

Appendiceal inflammation in colectomy is independently correlated with early pouchitis following ileal pouch anal anastomosis in ulcerative colitis and indeterminate colitis

BackgroundAppendiceal inflammation in colectomy is one of the histologic predictors of pouchitis in ulcerative colitis (UC) following ileal pouch anal anastomosis (IPAA). Fecal calprotectin level has been shown to increase 2 months prior to the onset of pouchitis. We evaluated whether inflammation and calprotectin expression in appendiceal specimens correlate with early-onset pouchitis in UC and indeterminate colitis (IC). Materials and methodsIPAA (2000-2018) cases with appendix blocks available in colectomy specimens were identified (n = 93, 90 UC, 3 IC). Histologic features thought to predict pouchitis were evaluated. The degree of appendiceal inflammation was scored. Calprotectin immunostain was performed on the appendix blocks and the extent of mucosal staining was quantified. Electronic medical records were reviewed for demographics, smoking history, clinical pouchitis, time of onset of pouchitis, and clinical and endoscopic components of the Pouchitis Disease Activity Index (PDAI) score. Follow-up pouch biopsies were reviewed and scored to generate histologic PDAI score, when available. ResultsAmong the patients with clinical pouchitis (n = 73), moderate to severe appendiceal inflammation independently correlated with earlier pouchitis compared to no/mild inflammation (median time to pouchitis 12.0 vs. 23.8, log rank p = 0.016). Calprotectin staining correlated with inflammatory scores of the appendix (Spearman's rho, r = 0.630, p < 0.001) but not with early pouchitis (p > 0.05). ConclusionsThe presence of moderate to severe appendiceal inflammation at the time of colectomy was associated with a shorter time to pouchitis following IPAA. Calprotectin immunostain may be used to demonstrate the presence of inflammation in the appendix but its role in predicting early pouchitis remains limited.

S836 Preoperative Small Bowel Evaluation to Predict Crohn’s Disease Diagnosis After Total Proctocolectomy/Ileopouch Anal Anastomosis for Ulcerative Colitis

S836 Preoperative Small Bowel Evaluation to Predict Crohn’s Disease Diagnosis After Total Proctocolectomy/Ileopouch Anal Anastomosis for Ulcerative Colitis

Preoperative Endoscopic Activity Predicts the Occurrence of Pouchitis After Ileal Pouch-Anal Anastomosis in Ulcerative Colitis: A Multicenter Retrospective Study in China.

Background: Pouchitis is the most common long-term complication after ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Ulcerative colitis endoscopic index of severity (UCEIS) and Mayo endoscopic score (MES) are widely used indices to evaluate endoscopic activity. This study aimed to clarify the predictive value of preoperative endoscopic activity on the occurrence of pouchitis after IPAA.Methods: Data of patients with UC who underwent IPAA from January 2008 to January 2020 were collected retrospectively. UCEIS and MES were based on the preoperative colonoscopy findings of two independent endoscopists.Results: A total of 102 patients with a median follow-up of 5 (interquartile range, 2–9) years were included in the study. Among them, 21.6% developed pouchitis. Compared with MES, UCEIS had a stronger correlation with pouchitis disease activity index. UCEIS ≥ 7 had the most significant receiver-operating characteristic (ROC) curve area of 0.747 with a sensitivity of 68.2% and specificity of 81.2% in predicting pouchitis, which outperformed MES of 3 with an ROC area of 0.679 with a sensitivity of 54.5% and specificity of 81.2%. Furthermore, we found that UCEIS ≥ 7 was an independent risk factor for post-IPAA pouchitis [odds ratio (OR), 8.860; 95% CI, 1.969–39.865, p < 0.001] with a higher risk than MES of 3 (OR, 5.200; 95% CI, 1.895–14.273; p = 0.001).Conclusion: Ulcerative colitis endoscopic index of severity performed better in predicting pouchitis after IPAA than MES. Earlier and more frequent postoperative colonoscopic surveillance should be considered in patients with preoperative UCEIS ≥ 7 to detect the occurrence of pouchitis earlier.

Comparative study between open and laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: a propensity score-matched study

Background The purpose of the study was to compare laparoscopic vs open restorative total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) for ulcerative colitis regarding safety, feasibility, and postoperative outcome. Patients and methods This is a propensity score-matched study of cases that underwent TPC-IPAA for ulcerative colitis from February 2009 to December 2017. The data were collected from a prospectively maintained web-based hospital registry. Cases were distributed TPC-IPAATPC-IPAA into two classes depending on the form of method: group I (open TPC-IPAA) and group II (laparoscopic TPC-IPAA). Results The duration of the operation was significantly longer in the laparoscopic group (P=0.0001). The length of the wound is significantly longer in the open group (P=0.0001). Postoperative pain was significantly less in the laparoscopic group. Patients in the laparoscopic group started oral intake earlier than the open group (P=0.0001). The incidence of overall postoperative morbidity was 39.3% in the laparoscopic group compared with 60.7% in the open group (P=0.11). Functional outcomes and postoperative anorectal manometry were comparable between both the groups. Conclusion Laparoscopic TPC-IPAA was equivalent to open TPC-IPAA in terms of health and viability. Laparoscopic TPC-IPAA showed superior postoperative cosmoses, less postoperative pain, earlier resumed oral intake, but with longer operating time.

The relationship between preoperative T helper cytokines in the ileal mucosa and the pathogenesis of pouchitis

BackgroundAlthough the etiology of pouchitis remains unknown, inflammatory cytokines are significantly associated with the pathogenesis of pouchitis. The cytokine responses that characterize inflammatory bowel diseases (IBD) are key pathogenic components of the disease. Although cytokine profiles in the colonic mucosa have been investigated in experimental colitis models or IBD patients, cytokine profiles in the ileal mucosa at colectomy have been rarely assessed.AimTo assess the relationship between pouchitis and T helper (Th) cytokines in the ileal mucosa collected at the time of colectomy and pouch construction.MethodsThis retrospective study involved 68 consecutive patients from January 2004 to May 2011 who underwent ileal pouch–anal anastomosis for ulcerative colitis. Samples were obtained from the terminal ileum of resected specimens at time of total colectomy or subtotal colectomy. mRNA expression levels of Th cytokines (IFN-γ, IL-23A, IL-5, IL-13 and IL-17A) were determined.ResultsForty of 68 patients (58.8%) developed pouchitis. There was no association between IL-23A expression levels and incidence of pouchitis (p = 0.301). Patients with elevated IFN-γ had a significantly higher incidence of pouchitis compared with low IFN-γ patients (p = 0.043). Univariate analysis demonstrated a total dose of prednisolone > 7000 mg administered before colectomy (p = 0.04) and high IFN-γ expression (p = 0.02) were significant risk factors for pouchitis onset. In multivariate analysis, elevated IFN-γ messenger(m)RNA levels were significantly associated with pouchitis onset (p = 0.03).ConclusionIFN-γ expression in the normal ileal mucosa at the time of colectomy may be an important factor in the pathophysiology of pouchitis.

Ileal pouch-anal anastomosis for ulcerative colitis: long-term outcomes and trends over time in a low-volume institution

Ileal pouch-anal anastomosis (IPAA) can restore bowel continuity for patients with ulcerative colitis (UC) who have needed total colectomy with end ileostomy. Internationally, this surgery is recommended for centralisation focussing reflection on Irish outcomes. Retrospective study examining patient outcomes after IPAA in our institution over a 15-year period using data from inflammatory bowel disease database, HIPE codes and clinical charts review between January 2002 and January 2018. Cohorts were analysed overall and in 5-year cohorts as well as by access modality of pouch operation. Contextualising Irish data were identified from published literature review. Thirty-four patients (average age 34.8, 21/64% male) had IPAA for UC locally with 64-month mean follow-up. Overall laparoscopic procedure rate was 39.4% (85% 2013-17) being associated with lower lengths of stay (10.6 ± 8 vs 12.7 ± 6.5days open access). The mean total duration of ileostomy was 27.3 ± 22.5months, being longest most recently and with an open index procedure. Overall pouchitis affected 53% (n = 18) with rates at 1, 5, 10 and 15years being 17.6%, 38.2, 50.0% and 52.9%, respectively. Pouch failure rates at 1, 5 and 10years were 2.9%, 11.8% and 17.6%. Outcomes were similar with other centres publishing from Ireland although none met modern criteria for high-volume practice. Overall outcomes and practice in this study are consistent with previously published studies on IPAA nationally and internationally. While acceptable, the opportunity from surgical centre collaboration outside of the National Cancer and Acute Surgery Strategies is to offer still better outcomes for our patients.

Is ileostomy mandatory for ileal pouch-anal anastomosis? A propensity matched analysis of 388 procedures

BackgroundRestorative proctocolectomy with ileal-pouch-anal anastomosis is the standard treatment for patients with ulcerative colitis or familial adenomatous polyposis. This procedure has undergone many changes and varies in 1, 2, or 3 stages. A diverting ileostomy can be created with the aim of reducing the consequence of an anastomotic leakage; however, its use is still unknown. MethodThe value of defunctioning ileostomy was studied in a population of 388 patients undergoing restorative proctocolectomy with ileal-pouch-anal anastomosis between 2005 and 2017. Leakage rate and postoperative morbidity were assessed. Patients were matched on a propensity score using the following criteria: American Society of Anesthesiologists score, body mass index, diagnosis, surgical approach, and year. ResultsTwo hundred and three ileal-pouch-anal anastomosis for ulcerative colitis and 185 for familial adenomatous polyposis were performed representing 165 1-stage (61.6%), 79 classic 2-stage, 74 modified 2-stage, and 70 3-stage procedures. Regardless of the surgical strategy adopted, there were no significant differences in postoperative morbidity (P = .416), leakage rate (P = .369), and reoperation (P = .237), whether a diverting ileostomy was performed or not. After propensity score matching, there was no significant difference in postoperative morbidity (P = .363), leakage rate (P = .247), or reoperation (P = .243). The rate of persistent ileostomy at 1 year was higher in cases of classic 2-stage or 3-stage procedures (P = .036). ConclusionAfter propensity score matching, defunctioning ileostomy for ileal-pouch-anal anastomosis does not reduce leakage rate or postoperative morbidity, independent of the surgical strategy. Systematic ileostomy for ileal-pouch-anal anastomosis is probably not justified, and its place should be redefined in a randomized trial.

Ileal pouch–anal anastomosis in ulcerative colitis: outcomes, functional results, and quality of life in patients with more than 10-year follow-up

Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). IPAA was incorporated into our institution in 1984, and thereafter, more than 200 procedures have been performed. The functional results and morbidity of this surgery have been reported previously. However, long-term functional outcomes and quality of life have not been evaluated. As a cohort study, we identified all consecutive patients who underwent IPAA for UC between 1984 and 2017 and selected those with more than 10-year follow-up. Demographic data, morbidity, and pouch survival information were obtained. Long-term functional results and quality of life were evaluated through an e-mail survey using the Öresland score and the Cleveland Global Quality of Life scales, respectively. Of 201 patients, 116 met the inclusion criteria. Median follow-up was 20 (10-34) years. Early post-operative complications (30days) were observed in 19 (16.4%) patients and 66 (56.9%) presented adverse events. The IPAA preservation rate at 10 and 20years was 96.5% and 93.1%, respectively. Long-term functional scores presented a median of 6 (1-15) points. IPAA function was satisfactory in 11 (20.0%) patients, acceptable in 18 (32.7%), and deficient in 26 (47.3%). The median score for global quality of life was 0.8 (0.23-1.0) points. IPAA as treatment for UC meets the expectations of cure of the disease, maintaining adequate long-term intestinal functionality associated with a good quality of life in most patients.

De Novo Crohn's Disease of the Pouch in Children Undergoing Ileal Pouch‐Anal Anastomosis for Ulcerative Colitis

Approximately 10% of children with ulcerative colitis (UC) undergo colectomy with ileal pouch-anal anastomosis (IPAA). We aimed to describe the postoperative outcomes, with an emphasis on chronic pouch inflammation including de novo Crohn disease (CD) at a tertiary care inflammatory bowel disease center. Electronic medical records of all children who underwent colectomy ≤18 years between 2008 and 2017 were reviewed. Clinical and laboratory data were recorded. Primary outcome was frequency of chronic pouch inflammation including de novo CD. Secondary outcomes included early (≤30 days from index surgery) and late postoperative complications. Descriptive statistics (median and interquartile range) summarized the data and univariate analysis tested associations with outcomes. Fifty-eight children underwent colectomy and 56 completed IPAA. Median age at diagnosis was 14 years (12-16.2) and at colectomy 16.2 years (14.2-17.7) with median follow-up of 13 months (5-43). Sixty-six percent underwent 3-stage IPAA and 78% were biologic exposed. Eleven had chronic pouchitis, 73% antibiotic refractory and 25% met criteria for de novo CD by median of 19 months (9-41). A total of 21% and 50% experienced early and late surgical complications, most commonly ileus and recurrent IPAA stricture. The pouch failure rate was 3.6%. Chronic pouch inflammation was associated with a later diagnosis of de novo CD (P = 0.0025). In pediatric UC, CD is not uncommon after IPAA. Chronic pouch inflammation often precedes a diagnosis of de novo CD. Families should be informed of the short- and long-term outcomes in children before UC surgery.

Sa1832 – Crohn’s Like Disease of the Ileal Pouch Anal Anastomosis in Ulcerative Colitis – Incidence, Risk Factors and Outcomes

Sa1832 – Crohn’s Like Disease of the Ileal Pouch Anal Anastomosis in Ulcerative Colitis – Incidence, Risk Factors and Outcomes

Mo1850 – Preoperative Anti-Tnfs are Associated with a Shorter Interval to De Novo Crohn’s Disease After Ileal Pouch-Anal Anastomosis For Ulcerative Colitis

Mo1850 – Preoperative Anti-Tnfs are Associated with a Shorter Interval to De Novo Crohn’s Disease After Ileal Pouch-Anal Anastomosis For Ulcerative Colitis

P300 Long-term surgical outcomes following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis in a tertiary IBD centre in Brazil

P300 Long-term surgical outcomes following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis in a tertiary IBD centre in Brazil

High Grade Dysplasia in the Ileal J-Pouch after Restorative Total Colectomy and Ileal J-Pouch-Anal Anastomosis for Ulcerative Colitis

High Grade Dysplasia in the Ileal J-Pouch after Restorative Total Colectomy and Ileal J-Pouch-Anal Anastomosis for Ulcerative Colitis

Clinical efficacy of laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

Objective To compare the short-term and long-term outcomes between laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Methods The retrospective cohort study was conducted. The clinical data of 150 UC patients who underwent total proctocolectomy with IPAA in the Renji Hospital of Shanghai Jiaotong University between January 2003 and December 2016 were collected. Among 150 patients, 87 undergoing laparoscopic total proctocolectomy with IPAA and 63 undergoing open total proctocolectomy with IPAA were respectively allocated into the laparoscopy group and open group. Observation indicators: (1) comparisons of intra-and post-operative situations; (2) postoperative complications; (3) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to December 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Comparison between groups of count data was analyzed using the chi-square test. Results (1) Comparisons of intra-and post-operative situations: operation time, volume of intraoperative blood loss, time of initial intestinal stoma exsufflation and duration of hospital stay were respectively (306±3)minutes, (197±12)mL, (62.1± 1.8)hours, (8.2±0.4)days in the laparoscopy group and (224±4)minutes, (308±24)mL, (75.6±2.0)hours, (10.1±0.6)days in the open group, with statistically significant difference between groups (t=16.23, 4.33, 5.03, 2.61, P 0.05). (2) Postoperative complications: cases with postoperative wound infection, retention of urine and frequency of defecation > 4 times / day were respectively 2, 8, 21 in the laparoscopy group and 8, 15, 29 in the open group, with statistically significant differences between groups (χ2=5.25, 4.37, 0.96, P 0.05). Patients with postoperative complications were improved by acid suppression, fasting, anti-infection and fluid infusion. (3) Follow-up situation: 150 patients were followed up for 12-60 months, with a median time of 48 months. There was no abnormality of postoperative anastomotic stoma and intestinal mucosa through comparison of colonoscopy results between pre-operation and 5 year postoperatively. During the follow-up, 50 patients had shapeless stool and irregular defecation (times > 4 times / day) at 3 years after stoma reversion of small intestine bypass, including 21 in the laparoscopy group and 29 in the open group, with a statistically significant differences between groups (χ2=4.72, P 0.05). Conclusion The security of laparoscopic total proctocolectomy with IPAA for UC is equivalent to that of open total proctocolectomy, with the better short-term and long-term outcomes. Key words: Ulcerative colitis; Total proctocolectomy; Ileal pouch-anal anastomosis; Laparoscopy; Efficacy

Transanal completion proctectomy with close rectal dissection and ileal pouch‐anal anastomosis for ulcerative colitis

Laparoscopic dissection in the pelvis is still a challenge. A transanal approach to rectal dissection allows better visualization during the dissection of the rectum and the creation of an anastomosis. Although initially used for patients with rectal cancer, the transanal approach may also have benefits in the surgical treatment of ulcerative colitis (UC). The aim of this study was to describe our initial experience with transanal completion proctectomy and ileal pouch-anal anastomosis for UC. This study included all consecutive patients who underwent transanal completion proctectomy and ileal pouch-anal anastomosis for UC between September 2017 and February 2018. Eleven patients were included in the study; they had a median age of 30 years (range, 13-51 years). The median operative time was 285 min (range, 190-375 min). There were no intraoperative complications or conversions to open surgery. Postoperative complications occurred in only one patient (anastomotic leak), and the median length of hospital stay was 7 days (range, 5-37 days). Our initial experience with transanal completion proctectomy and ileal pouch-anal anastomosis shows promising results, demonstrating the feasibility of the transanal approach in patients with UC.