Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis

Fuhrer, Audelia Eshel; Kammar, Haguy; Herzlich, Jacky; Sukhotnik, Igor

doi:10.1007/s00383-022-05222-y

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…Two recent meta-analyses showed similar short-term outcomes between the 2 approaches. 68,69 Functional outcomes also appear to be comparable. 70,71 Similar to robotics, the use of a transanal approach to IPAA is currently related to surgical confidence and technological availability.…”

Section: Transabdominal Versus Transanal Ipaamentioning

confidence: 82%

State of the Art: Pouch Surgery in the 21st Century

Maspero,

Hull

2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: An ileoanal pouch with ileal pouch-anal anastomosis is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations. OBJECTIVE: To review the main changes in pouch surgery during the last two decades, with focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration. RESULTS: The decision on the number of stages depends on the patient’s conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open in the hostile pelvis. The J pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn’s disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications. CONCLUSIONS: Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each individual patient. See video from symposium.

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Section: Transabdominal Versus Transanal Ipaamentioning

confidence: 82%

State of the Art: Pouch Surgery in the 21st Century

Maspero,

Hull

2024

Diseases of the Colon &Amp; Rectum

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“…Differences in the categorisation of perianastomotic pelvic abscesses without evidence of intraluminal communication, and the diagnostic modalities used between papers may account for the heterogeneity in leak rates. Similarly to our findings, a prior meta-analysis focused on the applicability of Ta-IPAA in the paediatric setting showed outcomes comparable to abd-IPAA (anastomotic leak rate 7.1%, odds ratio 1.36; 95% CI 0.46–4.06, I 2 = 68%) however a statistically significant difference between LoS was not demonstrated (mean LoS 7.4 days, 95% CI 6–8.8, odds ratio 0.61 days; 95% CI 2.39–1.17) [ 73 ]. Functional outcomes after Ta-IPAA appear to be comparable with a transabdominal approach, in keeping with a narrative review of papers specifically investigating functional outcomes after Ta-IPAA [ 74 ] but was limited to 1 year follow-up or less.…”

Section: Discussionmentioning

confidence: 99%

Transanal ileal pouch-anal anastomosis: A systematic review and meta-analysis of technical approaches and clinical outcomes

Stephens,

Byrnes,

Burke

2024

Langenbecks Arch Surg

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Purpose Transanal minimally invasive surgery has theoretical advantages for ileal pouch-anal anastomosis surgery. We performed a systematic review assessing technical approaches to transanal IPAA (Ta-IPAA) and meta-analysis comparing outcomes to transabdominal (abd-IPAA) approaches. Methods Three databases were searched for articles investigating Ta-IPAA outcomes. Primary outcome was anastomotic leak rate. Secondary outcomes included conversion rate, post operative morbidity, and length of stay (LoS). Staging, plane of dissection, anastomosis, extraction site, operative time, and functional outcomes were also assessed. Results Searches identified 13 studies with 404 unique Ta-IPAA and 563 abd-IPAA patients. Anastomotic leak rates were 6.3% and 8.4% (RD 0, 95% CI -0.066 to 0.065, p = 0.989) and conversion rates 2.5% and 12.5% (RD -0.106, 95% CI -0.155 to -0.057, p = 0.104) for Ta-IPAA and abd-IPAA. Average LoS was one day shorter (MD -1, 95% CI -1.876 to 0.302, p = 0.007). A three-stage approach was most common (47.6%), operative time was 261(± 60) mins, and total mesorectal excision and close rectal dissection were equally used (49.5% vs 50.5%). Functional outcomes were similar. Lack of randomised control trials, case-matched series, and significant study heterogeneity limited analysis, resulting in low to very low certainty of evidence. Conclusions Analysis demonstrated the feasibility and safety of Ta-IPAA with reduced LoS, trend towards less conversions, and comparable anastomotic leak rates and post operative morbidity. Though results are encouraging, they need to be interpreted with heterogeneity and selection bias in mind. Robust randomised clinical trials are warranted to adequately compare ta-IPAA to transabdominal approaches.

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“…Although a large number of reports have shown that total colectomy and IPAA surgery can be used in the treatment of children with ulcerative colitis, they are mostly used in older children and have a high complication rate. [31][32][33] Extensive colectomy and ileal pouch-anal anastomosis are not recommended for primary VEO-IBD surgery according to the existing literature. [34][35][36] This study also showed that more than half of the children underwent re-operation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for stoma-and-incision-related complications in children with very early-onset inflammatory bowel disease: A prospective cohort study

Zhou

Tan

et al. 2023

Preprint

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Objective To describe the incidence of postoperative complications of enterostomy and explore the related risk factors in children with very early-onset inflammatory bowel disease (VEO-IBD). Methods Forty-three children with VEO-IBD who underwent enterostomy from January 2015 to December 2021 were included. Patients were divided into two groups according to whether they had complications after the enterostomy. The T-test and the Chi-square test were used to analyze the influencing factors of two groups of enterostomy complications. Factors screened out by univariate analysis were included in binary logistic regression. Results There were 23(53.5%) VEO-IBD patients who had ostomy complications, 16(37.2%) patients who had peristomal complications, and 15 (34.9%) patients who had incision complications after enterostomy. Univariate analysis showed that there were significant differences in Weight-for-Age Z Score (WAZ), Height-for-Age Z Score (HAZ), and weighted Pediatric Crohn's Disease Activity Index (wPCDAI) among groups with and without complications (P < 0.05). Further multivariate logistic regression analysis showed that wPCDAI was an independent risk factor for stoma-and-incision complications after enterostomy in children with VEO-IBD (P = 0.02, OR = 1.13, 95%CI = 1.02–1.25). Conclusion wPCDAI score should be fully considered before the enterostomy procedure in children with VEO-IBD.

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Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis

Cited by 5 publications

References 35 publications

State of the Art: Pouch Surgery in the 21st Century

State of the Art: Pouch Surgery in the 21st Century

Transanal ileal pouch-anal anastomosis: A systematic review and meta-analysis of technical approaches and clinical outcomes

Risk factors for stoma-and-incision-related complications in children with very early-onset inflammatory bowel disease: A prospective cohort study

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