Does Mesorectal Preservation Protect the Ileoanal Anastomosis after Restorative Proctocolectomy?

Abstract

The low incidence of local septic complications in this series might at least in part result from the preservation of the mesorectum. As most studies do not specify the technique of rectal dissection, this theory cannot be verified by an analysis of the literature and needs further approval by a randomized trial.

Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies

“…It is, however, associated with substantial morbidity with complications up to 50% of patients [1]. Since its introduction in 1978, the IPAA procedure has continuously been subjected to attempts of improvements in technique [55]. Additionally, much has been achieved in improving the perioperative care.…”

Robotic-Assisted Proctectomy for Inflammatory Bowel Disease: A Case-Matched Comparison of Laparoscopic and Robotic Technique

“…14 Rink et al, on the other hand, prefer to preserve the mesorectal fat when performing IPAA for patients with ulcerative colitis, citing a lower rate of local septic complications. 15 This, however, has not been verified in a comparison study, and most reports in the literature do not specify the technique for rectal dissection for benign disease, making a retrospective analysis difficult. Total mesorectal excision, according to some authors, can increase risk of sexual dysfunction since the dissection occurs very close to the pelvic autonomic nerves.…”

Ileal Pouch Anal Anastomosis with Close Rectal Dissection Using Automated Vessel Sealers for Ulcerative Colitis: A Promising Alternative

“…A larger study with long-term follow-up will be needed to reliably assess the hypothesized benefits of CR-IPAA. There are twelve studies reporting to have used the close rectal dissection technique [14,15,16,17,18,28,29,30,31,32,33,34]. One study [34] has a population with both close rectal and TME, so the results of this study cannot be analyzed.…”

“…One study [34] has a population with both close rectal and TME, so the results of this study cannot be analyzed. However, the five largest studies, with over 100 patients, show contradictory results; Rink et al [18] and Berry et al [14] show a very low leakage rate and no autonomic nerve damage, respectively, due to close rectal dissection. However, Jarvinen and Luukkonen [15], Araki et al [28], and Régimbeau et al [33] present a normal leakage rate and sexual dysfunction percentage comparable to those found with the conventional technique.…”

“…With the development of the electrothermal bipolar vessel sealer (EBVS) and ultrasound dissection [13] the technique has been substantially simplified. Several series have since shown that this technique is safe and promising [14,15,16,17,18]. The main distinction of the CRD technique is in the way the dissection of the rectum is performed.…”