Transanal Proctectomy vs Laparoscopic IPAA Has Similar 30-Day Outcomes in Ulcerative Colitis

A transanal proctectomy (ta) with ileal pouch-anal anastomosis (IPAA) procedure was safe and associated with acceptable short-term outcomes for the treatment of ulcerative colitis (UC), according to study results published in Techniques in Coloproctology.

This single-center retrospective study was conducted at the Copenhagen University Hospital Hvidovre in Denmark between 2013 and 2020. All patients (N=135) with UC who underwent ta-IPAA (n=65) or laparoscopic IPAA (lap-IPAA; n=70) were evaluated for safety and 30-day outcomes.

The ta- and lap-IPAA groups included patients with a mean age of 32±12 and 30±12 years; 52% and 50% were men; BMI was 23±4.5 and 22±3.3 kg/m²; 84.6% and 72.9% were American Society of Anesthesiologist (ASA) class II; 93.7% and 97% used preoperative steroids; and 98.4% and 81.8% used preoperative biologics or immunomodulators (P =.002), respectively.

During surgery, the ta-IPAA recipients had more suprapubic (23% vs 0%) and midline (3% vs 0%) pouches and fewer ileostomy site (74% vs 100%) pouches (P =.001), they had longer operations (mean, 277 vs 224 min; P =.001), and larger anvil sizes (mean, 31 vs 30 mm; P =.003) compared with the lap-IPAA group, respectively. No patients required conversion to open surgery. The ta-IPAA cohort had a longer time between stoma closure and J-pouch operation (mean, 15 vs 9 weeks; P =.048).

Most patients in the ta-IPAA (98.4%) and lap-IPAA (98.6%) groups had ileostomy closure and the average hospital length of stay was 8 and 9 days, respectively.

The ta-IPAA group had a mean follow-up of 24 months and the lap-IPAA group a 75-month follow-up (P =.001). During which time, no outcomes differed significantly between groups.

Specifically, the ta- and lap-IPAA groups had a 30-day morbidity rate of 23.1% and 22.9% of which 13.3% and 29.4% were pouch related, 1.5% and 4.3% had anastomotic leakage, 20% and 18.6% underwent reoperation, and 26.2% and 28.6% were readmitted to the hospital, respectively.

The major limitation of this study was the non-randomized, observational design.

These data indicated that a ta-IPAA approach was safe and had similar 30-day outcomes compared with lap-IPAA among patients with UC.

“Our results suggest that evolving experience with the transanal approach together with careful patient selection, standardization of rectal dissection and anastomotic technique may improve surgical outcome,” the study authors wrote.