Transanal minimally invasive proctectomy with ileal pouch anal anastomosis (Ta-IPAA) in patients with ulcerative colitis: a cohort study from the TaTME international database

Abstract

BACKGROUND:Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) can achieve excellent outcomes in terms of function and quality of life, for patients refractory to medical therapy for ulcerative colitis (UC). Minimally invasive approaches are gaining momentum and evolution of the transanal approach to rectal surgery has led to broadening its use, from total mesenteric excision (TME) in cancer, to include IPAA in ulcerative colitis. In this study, we analysed the short-term outcomes of transanal minimally invasive IPAA (Ta-IPAA) within the International TaTME registry.METHODS:The TaTME registry, a secure online database was interrogated from 2014 to 2017 for benign conditions. Data were collected across 11 international centres submitted for patients who received Ta-IPAA, with or without TME, for UC. RESULTS:Sixty-nine patients with a median age of 38.6 ± 12.2 years were entered into the database. The majority of patients were male (75.4%; 52/69) and had a median BMI of 24.4 ± 4 kg/m2. There were no smokers in our cohort. Over half of the patients (53.6; 37/69) had active IBD at the time of surgery and 12 patients were on steroids at the time of the surgery. A proctectomy in the TME plane was the most common approach (75.4%; 52/69), a close rectal dissection was chosen in 13 patients and in four patients the plane was not specified. A simultaneous abdominal/TaTME approach was performed in over two-thirds of cases (69.6%; 48/69) and most surgeons either used an SILS approach (46.4%; 32/69) or a laparoscopic approach (40.6%; 28/69). A pursestring was used by the majority (87%; 60/69) at a median height of 4 ± 1.6 cm. The majority of pouches were created using a stapler (85.1%; 57/69) at a median distance of 2.9 ± 1.5 cm from the anal verge. Median operative time was 311 ± 126 min. Under a quarter of abdominal operations were converted (24.6%; 14/57) compared with four cases (5.8%) in the perineal phase. The median length of postoperative stay was 10 ± 6 days and three patients had a re-operation. There were no mortalities. Three patients (4.3%) had an anastomotic leak and two patients (2.9%) had collections. Late morbidity (>1 month) was available in 31 patients and of these seven patients (22.6%) had a stricture. CONCLUSIONS: Transanal minimally invasive proctectomy with ileal pouch anal anastomosis is feasible and safe in patients with UC. It is also associated with relatively low rates of re-operation and anastomotic leakage.