World Journal of Surgery

, Volume 42, Issue 11, pp 3746–3754 | Cite as

Case-Matched Comparison of Long-Term Functional and Quality of Life Outcomes Following Laparoscopic Versus Open Ileal Pouch-Anal Anastomosis

  • Olga A. Lavryk
  • Luca StocchiEmail author
  • Jean H. Ashburn
  • Meagan Costedio
  • Emre Gorgun
  • Tracy L. Hull
  • Hermann Kessler
  • Conor P. Delaney
Original Scientific Report



Laparoscopic ileal pouch–anal anastomosis (IPAA) is associated with recovery benefits when compared with open IPAA. There is limited data on long-term quality of life and functional outcomes, which this study aimed to assess.


An IRB-approved, prospectively maintained database was queried to identify patients undergoing laparoscopic IPAA (L), case-matched with open IPAA (O) based on age ± 5 years, gender, body mass index (BMI) ± 5 kg/m2, diagnosis, date of surgery ± 3 years, stapled/handsewn anastomosis, omission of diverting loop ileostomy and length of follow-up ± 3 years. We assessed functional results, dietary, social, work, sexual restrictions and the Cleveland Clinic global quality of life score (CGQoL) at 1, 2, 3, 4, 5 and 10 years postoperatively. Functional outcomes were assessed based on number of stools (day/night) and seepage protection use (day/night). Variables were evaluated with Kaplan–Meier survival curves, uni- and multivariable analyses.


Out of 4595 IPAAs, 529 patients underwent L, of whom 404 patients were well matched 1:1 to an equivalent number of O based on all criteria. Median follow-ups were 2 (0.5–17.8) versus 2.4 (0.5–22.2) years in L versus O, respectively (p = 0.18). L was associated with significantly decreased number of stools at night and less frequent pad usage at 1 year, both during the day and at night. Functional outcomes became similar during further follow-up. L was also associated with improved overall CGQoL, and energy scores at 1 year postoperatively, and decreased social restrictions for 1–2 years. There were no significant differences in quality of health, dietary, work or sexual restrictions. Laparoscopy was not associated with increased risk of pouch failure (p = 0.07) or significantly different causes of pouch failure when compared to O.


Laparoscopic and open IPAA are associated with equivalent long-term functional outcomes, quality of life and pouch survival rates. Laparoscopic technique is associated with temporary benefits lasting 1 or 2 years.


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685CrossRefGoogle Scholar
  2. 2.
    Jackson KL, Stocchi L, Duraes L, Rencuzogullari A, Bennett AE, Remzi FH (2017) Long-term outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis: function, quality of life, and complications. J Gastrointest Surg 21(1):56–61CrossRefGoogle Scholar
  3. 3.
    Erkek AB, Church JM, Remzi FH (2007) Age-related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. J Gastroenterol Hepatol 22(5):710–714CrossRefGoogle Scholar
  4. 4.
    El-Gazzaz GS, Kiran RP, Remzi FH, Hull TL, Geisler DP (2009) Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy. Br J Surg 96(5):522–526CrossRefGoogle Scholar
  5. 5.
    Schiessling S, Leowardi C, Kienle P, Antolovic D, Knebel P, Bruckner T et al (2013) Laparoscopic versus conventional ileoanal pouch procedure in patients undergoing elective restorative proctocolectomy (LapConPouch Trial)-a randomized controlled trial. Langenbecks Arch Surg 398(6):807–816CrossRefGoogle Scholar
  6. 6.
    Polle SW, Dunker MS, Slors JF, Sprangers MA, Cuesta MA, Gouma DJ et al (2007) Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial. Surg Endosc 21(8):1301–1307CrossRefGoogle Scholar
  7. 7.
    Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 44(12):1800–1807CrossRefGoogle Scholar
  8. 8.
    Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F (2009) Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 13(3):526–532CrossRefGoogle Scholar
  9. 9.
    Larson DW, Dozois EJ, Piotrowicz K, Cima RR, Wolff BG, Young-Fadok TM (2005) Laparoscopic-assisted versus open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48(10):1845–1850CrossRefGoogle Scholar
  10. 10.
    Larson DW, Davies MM, Dozois EJ, Cima RR, Piotrowicz K, Anderson K et al (2008) Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum 51(4):392–396CrossRefGoogle Scholar
  11. 11.
    Morelli L, Guadagni S, Mariniello MD, Furbetta N, Pisano R, D’Isidoro C et al (2015) Hand-assisted hybrid laparoscopic-robotic total proctocolectomy with ileal pouch–anal anastomosis. Langenbecks Arch Surg 400(6):741–748CrossRefGoogle Scholar
  12. 12.
    Benlice C, Stocchi L, Costedio M, Gorgun E, Hull T, Kessler H et al (2015) Laparoscopic IPAA is not associated with decreased rates of incisional hernia and small-bowel obstruction when compared with open technique: long-term follow-up of a case-matched study. Dis Colon Rectum 58(3):314–320CrossRefGoogle Scholar
  13. 13.
    Berdah SV, Mardion RB, Grimaud JC, Barthet M, Orsoni P, Moutardier V et al (2009) Mid-term functional outcome of laparoscopic restorative proctocolectomy: a prospective study of 40 consecutive cases. J Laparoendosc Adv Surg Tech A 19(4):485–488CrossRefGoogle Scholar
  14. 14.
    Remzi FH, Aytac E, Ashburn J, Gu J, Hull TL, Dietz DW et al (2015) Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg 262(4):675–682CrossRefGoogle Scholar
  15. 15.
    Rencuzogullari A, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH (2017) Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution. Surg Endosc 31(3):1083–1092CrossRefGoogle Scholar
  16. 16.
    Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ, van Bodegraven AA, Bemelman WA (2004) Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 240(6):984–991CrossRefGoogle Scholar
  17. 17.
    Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230(4):575–584 discussion 584-6 CrossRefGoogle Scholar
  18. 18.
    Baek SJ, Lightner AL, Boostrom SY, Mathis KL, Cima RR, Pemberton JH, Larson DW, Dozois EJ (2017) Functional outcomes following laparoscopic ileal pouch-anal anastomosis in patients with chronic ulcerative colitis: long-term follow-up of a case-matched study. J Gastrointest Surg 21(8):1304–1308CrossRefGoogle Scholar
  19. 19.
    Hull TL, Joyce MR, Geisler DP, Coffey JC (2012) Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 99(2):270–275CrossRefGoogle Scholar
  20. 20.
    Indar AA, Efron JE, Young-Fadok TM (2009) Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 23(1):174–177CrossRefGoogle Scholar
  21. 21.
    Beyer-Berjot L, Joly F, Maggiori L, Corcos O, Bouhnik Y, Bretagnol F et al (2012) Segmental reversal of the small bowel can end permanent parenteral nutrition dependency: an experience of 38 adults with short bowel syndrome. Ann. Surg. 256(5):739–744 discussion 744-5 CrossRefGoogle Scholar
  22. 22.
    Tekkis PP, Fazio VW, Lavery IC, Remzi FH, Senagore AJ, Wu JS, Strong SA, Poloneicki JD, Hull TL, Church JM (2005) Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg 241(2):262–268CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Olga A. Lavryk
    • 1
  • Luca Stocchi
    • 1
    Email author
  • Jean H. Ashburn
    • 1
  • Meagan Costedio
    • 1
  • Emre Gorgun
    • 1
  • Tracy L. Hull
    • 1
  • Hermann Kessler
    • 1
  • Conor P. Delaney
    • 1
  1. 1.Department of Colorectal Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandUSA

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