The current state of the transanal approach to the ileal pouch-anal anastomosis

Lacy, F. Borja de; Keller, Deborah S.; Martin‐Perez, B.; Emile, Sameh Hany; Chand, Manish; Spinelli, Antonino; Lacy, Antonio M.

doi:10.1007/s00464-019-06674-5

Cited by 26 publications

(20 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While laparoscopic approaches for IPAA have been described since the 1990s and have been demonstrated to be feasible and safe[13], surgical techniques have progressed rapidly to robot-assisted techniques[14,15], single incision laparoscopic surgery (SILS)[16], transanal proctectomy (TaTME)[17], and natural orifice specimen extraction[18]. These new techniques promise to improve surgical accuracy, postoperative recovery, and postoperative pain, and while studies exist to demonstrate their feasibility[19], robust data regarding their efficacy in pouch surgery is awaited[20].…”

Section: History Of the Ileal Pouchmentioning

confidence: 99%

Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

View full text Add to dashboard Cite

The ileal pouch anal anastomosis (IPAA) has revolutionised the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Despite refinement in surgical technique(s) and patient selection, IPAA can be associated with significant morbidity. As the IPAA celebrated its 40 th anniversary in 2018, this review provides a timely outline of its history, indications, and complications. IPAA has undergone significant modification since 1978. For both UC and FAP, IPAA surgery aims to definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma. The majority of patients experience long-term success, but “early” and “late” complications are recognised. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of causes. Pouchitis is a common cause that remains incompletely understood and difficult to manage at times. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. This review provides a timely outline of the history, indications, and complications associated with IPAA. Patient selection remains key, and contraindications exist for this surgery. A structured management plan is vital to the successful management of complications following pouch surgery.

show abstract

Section: History Of the Ileal Pouchmentioning

confidence: 99%

Ileal-anal pouches: A review of its history, indications, and complications

Ng¹,

Gonsalves²,

Sagar³

2019

WJG

View full text Add to dashboard Cite

show abstract

“…In parallel with rectal cancer treatment, patients with UC have been proposed to have a bottom-up (transanal) approach in order to overcome these technical difficulties [38]. Ta-IPAA has the advantage of virtually abolishing the need for conversion to open surgery, independent of patient-related factors such as obesity and a narrow pelvis [6]. The feasibility of the technique has already been demonstrated in previous publications [39,40].…”

Section: Discussionmentioning

confidence: 99%

“…Whether or not multiple staged operations are needed is still a matter of debate, especially in the setting of preoperative exposure to biologics and immunosuppressants [4,5]. Furthermore, implementation of a transanal approach for pelvic dissection raises further questions about the possible contribution of this approach to avoiding intestinal diversion after IPAA [6]. The aim of this study was to present the results of a standardized modified two-stage approach by transanal minimally invasive IPAA without a diverting ileostomy in a cohort of UC patients refractory to medical therapy.…”

Section: Introductionmentioning

confidence: 99%

Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital

et al. 2020

View full text Add to dashboard Cite

Aim Ileal pouch–anal anastomosis (IPAA) should be delayed to a second stage in patients with ulcerative colitis and prolonged exposure to medical therapy. However, there is still discussion about whether a modified two‐stage approach is preferable to a three‐stage approach. Recently, a transanal approach has been introduced to overcome the well‐known difficulties of laparoscopic pelvic surgery. This paper presents short‐term outcomes of transanal IPAA (Ta‐IPAA) according to a modified two‐stage approach. Methods Data from all patients who underwent a modified two‐stage Ta‐IPAA for ulcerative colitis refractory to medical therapy were retrieved retrospectively from a prospective database. A comprehensive complication index was used for 90‐day postoperative complications. Conversion, duration of surgery, hospital stay and reoperation were considered. A logistic regression model was used to assess risk factors for peri‐pouch sepsis. Results Seventy‐five (68.8%) patients were identified from 109 consecutive IPAAs. Median operation time was 159 min. Conversion rate was 4%. Mean comprehensive complication index was 7. All anastomotic leaks (10.6%) were treated with diverting ileostomy. Additionally, active rescue with transanal drainage and early resuturing of the anastomotic gap was performed in six patients. Ileostomy closure occurred after a median period of 5.4 months. At univariable analysis, factors associated with peri‐pouch sepsis were male gender and age at IPAA construction. Conclusions A modified two‐stage Ta‐IPAA is safe and feasible. Standardization and reproducibility of the technique are reflected in few conversions and intra‐operative complications. Finally, morbidity and anastomotic leak do not differ from those reported in previous Ta‐IPAA series with a variable proportion of multistage procedures.

show abstract

“…A detailed description about the surgical technique and its variations is reported in the paper from Borja de Lacy et al 22 Here we report a summary of the surgical procedure. The operation can be performed in two-steps ( rst step: subtotal colectomy and trans-anal proctectomy, pouch construction and IPAA with diverting stoma; second step: stoma closure) or three-steps ( rst step: subtotal colectomy with endileostomy and no proctectomy; second step: trans-anal proctectomy, pouch construction, IPAA and diverting stoma; third step; stoma closure) according to the clinical conditions and choice of the patient 23 24 25 .…”

Section: Surgical Techniquementioning

confidence: 95%

Transanal Proctocolectomy and Ileal Pouch-Anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre

Capolupo

Carannante

Mascianà

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Transanal 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.Methods: Our 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.Results: Until 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.Conclusions: In our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.

show abstract

The current state of the transanal approach to the ileal pouch-anal anastomosis

Cited by 26 publications

References 47 publications

Ileal-anal pouches: A review of its history, indications, and complications

Ileal-anal pouches: A review of its history, indications, and complications

Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital

Transanal Proctocolectomy and Ileal Pouch-Anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre

Contact Info

Product

Resources

About