Transanal and Transabdominal IPAA Have Similar Postsurgical Outcomes in UC

There was no difference in postoperative outcomes between patients with UC who underwent transanal or transabdominal IPAA.

Postoperative complications were found to be similar between the novel transanal ileal pouch-anal anastomosis (IPAA) approach and the traditional transabdominal IPAA approach among patients with ulcerative colitis (UC), according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2022 conference, held from December 5 to 7, 2022, in Orlando, Florida.

Restorative proctocolectomy with abdominal IPAA has evolved as the standard treatment for medically refractive UC; however, this procedure is challenging to execute due to the bony structure of the deep pelvis.

To address this challenge, the novel transanal IPAA approach was developed, which offers increased visibility and range of motion compared with abdominal IPAA.

To compare the postoperative outcomes of transanal and transabdominal IPAA, researchers from the Cleveland Clinic Foundation conducted a systematic review and meta-analysis.

Publication databases through May 2022 were searched for comparative and noncomparative studies of IPAA approaches.

While the need for randomized controlled trials and comparison of functional outcomes between both approaches remains, this evidence should assist colorectal surgeons in deciding if the ta-IPAA is a viable alternative.

A total of 10 studies including 283 patients were included in the analysis. Most studies had a cutoff length of 1 to 2 cm from the transition zone; a total mesorectal excision was performed among 61.8% of patients and a close rectal dissection among the remaining patients.

Between the transanal and transabdominal IPAAs, the researchers did not observe a difference in risk for Clavien-Dindo I-II (odds ratio [OR], 0.96; 95% CI, 0.27-3.40; I2=83%) and Clavien-Dindo III-IV complications (OR, 1.18; 95% CI, 0.65-2.16; I2=0%).

The researchers did not observe a difference in risk for anastomotic leak between the transanal and transabdominal IPAA approaches (OR, 1.37; 95% CI, 0.58-3.23; I2=0%).

No deaths were reported with transanal IPAA.

Mean operative time (mean difference, -5.34; -24.01 to 13.32 min; I2=49%) and length of hospital stay (mean difference, -0.45; 95% CI, -2.93 to 2.03 days; I2=95%) were not different between transanal and transabdominal IPAAs.

A limitation of the analysis was that the risk for bias was moderate for 4 studies and high for 3 studies.

“While the need for randomized controlled trials and comparison of functional outcomes between both approaches remains, this evidence should assist colorectal surgeons in deciding if the [transabdominal] IPAA is a viable alternative,” the authors of the review concluded.

References:

Lincango E, Dominguez OH, Prien C, et al. Transanal ileal pouch-anal anastomosis for inflammatory bowel disease (ta-IPAA): a systematic review and meta-analysis. Abstract presented at: AIBD 2022; December 5-7, 2022; Orlando, FL. Abstract 35.