Short-term Surgical Outcomes After Transanal Restorative Proctocolectomy With IPAA: A Comparison of Close Rectal Dissection and Modified Total Mesorectal Excision.
Source: PubMed, NCBI / U.S. National Library of Medicine
The preferred treatment for patients with medically refractory ulcerative colitis is a restorative proctocolectomy with IPAA. The transanal approach has been adopted in many centers; however, the plane of dissection, number of surgical stages, and type of anastomosis differ, resulting in substantial heterogeneity in published studies. We aimed to compare short-term surgical outcomes of modified transanal total mesorectal excision and transanal close rectal dissection in the formation of transanal IPAA. Retrospective cohort study. Two referral centers responsible for transanal IPAA in Denmark. Patients older than 18 years with ulcerative colitis undergoing transanal IPAA from 2015 to 2023. Surgical complications in the first 30 postoperative days as registered in the surgical records. A total of 176 patients underwent transanal IPAA at the 2 centers: 78 patients with close rectal dissection and 98 patients with modified transanal total mesorectal excision. There was no significant difference in complications, including anastomotic leak (3 [4%] and 4 [4%] patients) and intra-abdominal abscesses (2 [3%] and 2 [2%] patients). The data were collected retrospectively and relied on uniformly reported complications. We did not calculate a study power but included all consecutive patients. There were comparable complications, including anastomotic leaks and intra-abdominal abscesses in the 2 groups, indicating they are equally safe procedures. See Video Abstract . ANTECEDENTES:El trat
Abstract
The preferred treatment for patients with medically refractory ulcerative colitis is a restorative proctocolectomy with IPAA. The transanal approach has been adopted in many centers; however, the plane of dissection, number of surgical stages, and type of anastomosis differ, resulting in substantial heterogeneity in published studies. We aimed to compare short-term surgical outcomes of modified transanal total mesorectal excision and transanal close rectal dissection in the formation of transanal IPAA. Retrospective cohort study. Two referral centers responsible for transanal IPAA in Denmark. Patients older than 18 years with ulcerative colitis undergoing transanal IPAA from 2015 to 2023. Surgical complications in the first 30 postoperative days as registered in the surgical records. A total of 176 patients underwent transanal IPAA at the 2 centers: 78 patients with close rectal dissection and 98 patients with modified transanal total mesorectal excision. There was no significant difference in complications, including anastomotic leak (3 [4%] and 4 [4%] patients) and intra-abdominal abscesses (2 [3%] and 2 [2%] patients). The data were collected retrospectively and relied on uniformly reported complications. We did not calculate a study power but included all consecutive patients. There were comparable complications, including anastomotic leaks and intra-abdominal abscesses in the 2 groups, indicating they are equally safe procedures. See Video Abstract . ANTECEDENTES:El tratamiento de elección para pacientes con colitis ulcerosa refractaria al tratamiento médico es la proctocolectomía restauradora con anastomosis ileoanal con reservorio. El abordaje transanal se ha adoptado en muchos centros; sin embargo, el plano de disección, el número de etapas quirúrgicas y el tipo de anastomosis varían. Esto genera heterogeneidad en los estudios existentes.OBJETIVO:Comparar los resultados quirúrgicos a corto plazo de la escisión mesorrectal total transanal modificada y la disección rectal transanal cerrada en la formación de la anastomosis ileoanal con reservorio transanal.DISEÑO:Estudio de cohorte retrospectivo.ÁMBITO:Dos centros de referencia responsables de la anastomosis ileoanal con reservorio transanal en Dinamarca.PACIENTES:Pacientes mayores de 18 años con colitis ulcerosa sometidos a anastomosis ileoanal con reservorio transanal entre 2015 y 2023.PRINCIPALES MEDIDAS DE RESULTADO:Complicaciones quirúrgicas durante los primeros 30 días postoperatorios, según consta en los registros quirúrgicos.RESULTADOS:Un total de 176 pacientes se sometieron a anastomosis ileoanal transanal con reservorio ileal en los dos centros: 78 pacientes con disección rectal cerrada y 98 pacientes con escisión mesorrectal total transanal modificada. No se observaron diferencias significativas en las complicaciones, como la fuga anastomótica (3 pacientes [4%] y 4 [4%]) o los abscesos intraabdominales (2 pacientes [3%] y 2 pacientes [2%], respectivamente).LIMITACIONES:Los datos se recopilaron retrospectivamente y se basaron en las complicaciones notificadas de forma uniforme. No se calculó la potencia estadística del estudio, pero se incluyeron todos los pacientes consecutivos.CONCLUSIONES:Las complicaciones fueron comparables en cuanto a fugas anastomóticas y abscesos intraabdominales en ambos grupos, lo que indica que ambos procedimientos son igualmente seguros. (AI-generated translation ).