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Title: | Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital | Authors: | Bislenghi, G. Martin-Perez, B. FIEUWS, Steffen Wolthuis, A. D'Hoore, A. |
Issue Date: | 2020 | Publisher: | WILEY | Source: | COLORECTAL DISEASE, | Abstract: | Aim Ileal pouch-anal anastomosis (IPAA) should be delayed to a second stage in patients with ulcerative colitis and prolonged exposure to medical therapy. However, there is still discussion about whether a modified two-stage approach is preferable to a three-stage approach. Recently, a transanal approach has been introduced to overcome the well-known difficulties of laparoscopic pelvic surgery. This paper presents short-term outcomes of transanal IPAA (Ta-IPAA) according to a modified two-stage approach. Methods Data from all patients who underwent a modified two-stage Ta-IPAA for ulcerative colitis refractory to medical therapy were retrieved retrospectively from a prospective database. A comprehensive complication index was used for 90-day postoperative complications. Conversion, duration of surgery, hospital stay and reoperation were considered. A logistic regression model was used to assess risk factors for peri-pouch sepsis. Results Seventy-five (68.8%) patients were identified from 109 consecutive IPAAs. Median operation time was 159 min. Conversion rate was 4%. Mean comprehensive complication index was 7. All anastomotic leaks (10.6%) were treated with diverting ileostomy. Additionally, active rescue with transanal drainage and early resuturing of the anastomotic gap was performed in six patients. Ileostomy closure occurred after a median period of 5.4 months. At univariable analysis, factors associated with peri-pouch sepsis were male gender and age at IPAA construction. Conclusions A modified two-stage Ta-IPAA is safe and feasible. Standardization and reproducibility of the technique are reflected in few conversions and intra-operative complications. Finally, morbidity and anastomotic leak do not differ from those reported in previous Ta-IPAA series with a variable proportion of multistage procedures. | Notes: | Bislenghi, G (corresponding author), Katholieke Univ Leuven, Univ Hosp Leuven, Dept Abdominal Surg, Herestr 49, B-3000 Leuven, Belgium. gabriele.bislenghi@uzleuven.be |
Other: | Bislenghi, G (corresponding author), Katholieke Univ Leuven, Univ Hosp Leuven, Dept Abdominal Surg, Herestr 49, B-3000 Leuven, Belgium. gabriele.bislenghi@uzleuven.be | Keywords: | Close rectal dissection;ileal pouch anal anastomosis;modified two-stage approach;surgery;transanal minimally invasive surgery;ulcerative colitis | Document URI: | http://hdl.handle.net/1942/32652 | ISSN: | 1462-8910 | e-ISSN: | 1463-1318 | DOI: | 10.1111/codi.15231 | ISI #: | WOS:000552879800001 | Rights: | ª 2020 The Association of Coloproctology of Great Britain and Ireland. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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