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Erschienen in:
10.06.2019
Rectal eversion: safe and effective way to achieve low transaction in minimally invasive Ileal pouch-anal anastomosis surgery, short- and long-term outcomes
Erschienen in: Surgical Endoscopy | Ausgabe 3/2020
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Background
Ileal pouch-anal anastomosis remains a gold standard in restoring continence in patient with ulcerative colitis. Achieving
low transection can be challenging and may require mucosectomy with a hand-sewn anastomosis. Rectal eversion (RE)
technique provides a safe and effective alternative for both open and minimally invasive approaches. The purpose of this
study is to evaluate short- and long-term outcomes of patients who underwent RE when compared to those who underwent
conventional trans-abdominal transection.
Materials and methods
This is a retrospective review performed at tertiary care center. Patients undergoing
proctectomy and pouch surgery by either standard approach or with RE from November 2004 to January 2017 were
evaluated. Demographics, post-operative complications, as well as 1- and 3-year functional outcomes were analyzed.
Results
Total of
176 underwent proctocolectomy with creation of a J pouch and 88 (50%) had the RE technique utilized. The RE group had a
higher rate of corticosteroid use at the time of surgery 59.1 versus 39.8% (p = 0.0156), but otherwise groups were statistically
similar. 20 cases (26.1%) of RE group and 54 (61%) of conventional group cases were accomplished in minimally invasive
fashion. There was no difference in the rates of 30- and 90-day complications. Functional outcomes data were available for
up to 78.4% of patient with trans-abdominal approach and 64.7% in RE group. At 1 and 3 years after surgery, there was no
difference in the number of bowel movements, fecal incontinence, or nocturnal bowel movements. The rates of returning to
ileostomy or pouch revision were the same.
Conclusion
RE technique is safe and effective way to achieve a low transaction in J pouch
surgery. The technique provides similar functional outcomes at 1 and 3 years after surgery and can be particularly useful in
minimally invasive approaches.