Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study
- Resource Type
- Authors
- Pramodh Chandrasinghe; Zarah L Perry‐Woodford; Caterina Foppa; Willem A. Bemelman; Karin A. T. G. M. Wasmann; Antonino Spinelli; Pieter J. Tanis; Michele Carvello; Janindra Warusavitarne
- Source
- Journal of Crohn's & colitis, 14(6), 726-733. Elsevier
- Subject
- Adult
Male
Reoperation
Comparative Effectiveness Research
medicine.medical_specialty
Urology
Anal Canal
Colonic Pouches
Long Term Adverse Effects
Anastomotic Leak
Urinary incontinence
Anastomosis
Postoperative Complications
Quality of life
medicine
Clinical endpoint
Humans
Pouch anal anastomosis
Lesser Pelvis
business.industry
Abdominal Wall
Proctocolectomy, Restorative
Gastroenterology
Recovery of Function
General Medicine
medicine.disease
Ulcerative colitis
Transanal surgery
Ileal Pouch Anal Anastomosis
Europe
Quality of Life
Colitis, Ulcerative
Female
medicine.symptom
Pouch
business
Cohort study
- Language
- ISSN
- 1876-4479
1873-9946
Background The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. Methods A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. Results A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.