Transanal Proctocolectomy And Ileal Pouch-Anal Anastomosis (TaIPAA) For Ulcerative Colitis: Medium Term Functional Outcomes In A Single Centre.

Abstract

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 IPAA (Ta-IPAA), considering postoperative complications and medium-term functional outcomes.Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since October 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 Ta-IPAA. 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. There were no cases of anastomotic leakage.Medium-term functional outcomes were determined prospectively by a validated questionnaire (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, Ta-IPAA provided good short and medium-term functional results in UC.

TaTME approach as a rescue during a laparoscopic TME for high rectal cancer. A case report

“…Ideal candidates to transanal approach are patients with narrow pelvis, prostate hypertrophy, visceral obesity or high body mass index (BMI > 30 Kg/m 2 ), tumor diameter>4 cm, distorted tissue planes due to neoadjuvant radiotherapy, difficult recognition of the distal resection margin and ultralow rectal tumors, allowing to preserve fecal continence [ 9 ]. This procedure could be performed in inflammatory bowel disease patients for a completion proctectomy to overcome some limitations of the traditional minimally invasive techniques, allowing better visualization in the low pelvis and easier dissection of the distal 5 cm of the rectum [ 11 ]. The described clinical benefits of TaTME are low circumferential margin positive rates, less morbidity and more sphincter-saving rectal resections compared to laparoscopic TME [ 12 ].…”