Pouch outcomes after minimally invasive vs. open proctectomy during IPAA reconstruction
- 20.02.2025
Erschienen in:
- Verfasst von
- Daniel Aryeh Metzger
- Andrea Mesiti
- Josh Johnson
- Ying Li
- Julianna Brouwer
- Morgan Manasa
- Sarah Lee
- Angela Hsu
- Mehraneh D. Jafari
- Alessio Pigazzi
- Erschienen in
- Surgical Endoscopy | Ausgabe 4/2025
Abstract
Background
There is limited data on pouch outcomes after minimally invasive (MIS) proctectomy during ileal pouch-anal anastomosis (IPAA). This study aimed to determine if MIS proctectomy is associated with differences in pouch complications compared to open.
Methods
We performed a retrospective cohort study of patients from two academic institutions (2010–2022) who underwent restorative proctectomy with IPAA for inflammatory bowel disease, excluding those with Crohn’s disease or Crohn’s-like disease of the pouch. Patients were categorized into Open and MIS groups based on surgical approach. Perioperative outcomes and rates of pouchitis, cuffitis, and pouch failure were compared. Patient, disease, and operative factors associated with risk of pouch complications were identified using multivariable regression.
Results
117 patients were included: 36 MIS and 81 Open. Median age at colectomy was 35 years, and 60% were male. Demographics, preoperative symptoms, medications, and surgical indications were comparable between groups. Rates of pouchitis (MIS 37% vs. Open 45%; p = 0.4), cuffitis (32% vs. 27%; p = 0.5), and pouch failure (5.6% vs. 6.2%; p > 0.9) were similar. MIS was associated with lower estimated blood loss (median 75 cc vs. 150 cc; p < 0.001). There were no differences in length of stay (MIS: 5 days vs. Open: 6 days; p = 0.2), operative time, or 30-day postoperative complications (HR 1.41; p = 0.5). There was a trend toward fewer anastomotic leaks in the MIS group (2.1% vs. 9.7%; p-0.2). On multivariable analysis, only initial colectomy for an indication of acute severe ulcerative colitis (HR 6.21; p = 0.044) and \(\geq\) 5 bowel movements per day preoperatively (HR 3.58; 95% CI 1.10–13.1; p-0.041) were significantly associated with risk of pouchitis or cuffitis.
Conclusions
MIS proctectomy is associated with equivalent long-term pouch outcomes compared to open proctectomy. There may be a reduced risk of anastomotic leak with MIS and other perioperative outcomes were similar between groups. Patient and disease factors, but not operative factors, were associated with risk of pouch complications.
Anzeige
- Titel
- Pouch outcomes after minimally invasive vs. open proctectomy during IPAA reconstruction
- Verfasst von
-
Daniel Aryeh Metzger
Andrea Mesiti
Josh Johnson
Ying Li
Julianna Brouwer
Morgan Manasa
Sarah Lee
Angela Hsu
Mehraneh D. Jafari
Alessio Pigazzi
- Publikationsdatum
- 20.02.2025
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 4/2025
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-025-11574-y
Dieser Inhalt ist nur sichtbar, wenn du eingeloggt bist und die entsprechende Berechtigung hast.
Dieser Inhalt ist nur sichtbar, wenn du eingeloggt bist und die entsprechende Berechtigung hast.
