Skip to main content

Advertisement

SpringerLink
Log in

Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Purpose

Initial reports of transanal ileal pouch-anal anastomosis (taIPAA) suggest safety and feasibility compared with transabdominal IPAA. The purpose of this study was to evaluate differences in technique and results of taIPAA in three centers performing taIPAA across two continents.

Methods

Prospective IPAA registries from three institutions in the US and Europe were queried for patients undergoing taIPAA. Demographic, preoperative, intraoperative, and postoperative data were compiled into a single database and evaluated.

Results

Sixty-two patients (median age 38 years; range 16–68 years, 43 (69%) male) underwent taIPAA in the three centers (USA 24, UK 23, Italy 15). Most patients had had a subtotal colectomy before taIPAA [n = 55 (89%)]. Median surgical time was 266 min (range 180–576 min) and blood loss 100 ml (range 10–500 ml). Technical variations across the three institutions included proctectomy plane of dissection (intramesorectal or total mesorectal excision plane), specimen extraction site (future ileostomy site vs. anus), ileo-anal anastomosis technique (stapled vs. hand sewn) and use of fluorescence angiography. Despite technical differences, anastomotic leak rates (5/62; 8%) and overall complications (18/62; 29%) were acceptable across the three centers.

Conclusions

This is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Baek SJ, Dozois EJ, Mathis KL, Lightner AL, Boostrom SY, Cima RR, Pemberton JH, Larson DW (2016) Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience. Tech Coloproctol 20:369–374

    Article  Google Scholar 

  2. Rencuzogullari A, Gorgun E, Costedio M, Aytac E, Kessler H, Abbas MA, Remzi FH (2016) Case-matched comparison of robotic versus laparoscopic proctectomy for inflammatory bowel disease. Surg Laparosc Endosc Percutan Tech 26:e37–e40

    Article  Google Scholar 

  3. Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243:667–670 (discussion 70–72)

    Article  Google Scholar 

  4. White I, Jenkins JT, Coomber R, Clark SK, Phillips RK, Kennedy RH (2014) Outcomes of laparoscopic and open restorative proctocolectomy. Br J Surg 101:1160–1165

    Article  CAS  Google Scholar 

  5. 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 99:270–275

    Article  CAS  Google Scholar 

  6. Polle SW, Dunker MS, Slors JF, Sprangers MA, Cuesta MA, Gouma DJ, Bemelman WA (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 21:1301–1307

    Article  CAS  Google Scholar 

  7. Hiranyakas A, Rather A, da Silva G, Weiss EG, Wexner SD (2013) Loop ileostomy closure after laparoscopic versus open surgery: is there a difference? Surg Endosc 27:90–94

    Article  Google Scholar 

  8. Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y (2013) A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 258:275–282

    Article  Google Scholar 

  9. Benlice C, Gorgun E (2016) Single-port laparoscopic restorative proctocolectomy with ileal-pouch anal anastomosis using a left lower quadrant ileostomy site—a video vignette. Colorectal Dis 18:818–819

    Article  CAS  Google Scholar 

  10. Gash KJ, Goede AC, Kaldowski B, Vestweber B, Dixon AR (2011) Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis. Surg Endosc 25:3877–3880

    Article  CAS  Google Scholar 

  11. Remzi FH, Lavryk OA, Ashburn JH, Hull TL, Lavery IC, Dietz DW, Kessler H, Church JM (2017) Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care. Colorectal Dis 19:1003–1012

    Article  CAS  Google Scholar 

  12. Sylla P, Rattner DW, Delgado S, Lacy AM (2014) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  Google Scholar 

  13. Atallah S (2014) Transanal minimally invasive surgery for total mesorectal excision. Minim Invasive Ther Allied Technol 23:10–16

    Article  Google Scholar 

  14. Chouillard E, Regnier A, Vitte RL, Bonnet BV, Greco V, Chahine E, Daher R, Biagini J (2016) Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved? Tech Coloproctol 20:537–544

    Article  CAS  Google Scholar 

  15. de Lacy FB, van Laarhoven J, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32:2442–2447

    Article  Google Scholar 

  16. Persiani R, Biondi A, Pennestri F, Fico V, De Simone V, Tirelli F, Santullo F, D’Ugo D (2018) Transanal total mesorectal excision vs laparoscopic total mesorectal excision in the treatment of low and middle rectal cancer: a propensity score matching analysis. Dis Colon Rectum 61:809–816

    PubMed  Google Scholar 

  17. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  Google Scholar 

  18. de Buck van Overstraeten A, Wolthuis AM, D’Hoore A (2016) Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique. Colorectal Dis 18:141–144

    Article  Google Scholar 

  19. Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J (2016) Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis 18:1162–1166

    Article  CAS  Google Scholar 

  20. de Buck van Overstraeten A, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM, Vanbrabant K, D’Hoore A, Bemelman WA, Tottrup A, Tanis PJ (2017) Te Ann Surg 266:878–883

    Article  Google Scholar 

  21. Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251

    Article  CAS  Google Scholar 

  22. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, Caprilli R, Colombel JF, Gasche C, Geboes K, Jewell DP, Karban A, Loftus EV Jr, Pena AS, Riddell RH, Sachar DB, Schreiber S, Steinhart AH, Targan SR, Vermeire S, Warren BF (2005) Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19(Suppl A):5–36

    Article  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  24. Bartels SA, Gardenbroek TJ, Aarts M, Ponsioen CY, Tanis PJ, Buskens CJ, Bemelman WA (2015) Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis. Br J Surg 102:281–287

    Article  CAS  Google Scholar 

  25. Li W, Benlice C, Stocchi L, Kessler H, Gorgun E, Costedio M (2017) Does stoma site specimen extraction increase postoperative ileostomy complication rates? Surg Endosc 31:3552–3558

    Article  Google Scholar 

  26. Denost Q, Adam JP, Pontallier A, Celerier B, Laurent C, Rullier E (2015) Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer. Ann Surg 261:138–143

    Article  Google Scholar 

  27. Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA (2014) The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 28:1695–1702

    Article  Google Scholar 

  28. James DR, Ris F, Yeung TM, Kraus R, Buchs NC, Mortensen NJ, Hompes RJ (2015) Fluorescence angiography in laparoscopic low rectal and anorectal anastomoses with pinpoint perfusion imaging–a critical appraisal with specific focus on leak risk reduction. Colorectal Dis 17(Suppl 3):16–21

    Article  Google Scholar 

  29. Spinelli A, Cantore F, Kotze PG, David G, Sacchi M, Carvello M (2017) Fluorescence angiography during transanal trans-stomal proctectomy and ileal pouch anal anastomosis: a video vignette. Colorectal Dis. https://doi.org/10.1111/codi.13992

    Article  PubMed  Google Scholar 

  30. Lee L, Kelly J, Nassif GJ, deBeche-Adams TC, Albert MR, Monson JRT (2018) Defining the learning curve for transanal total mesorectal excision for rectal adenocarcinoma. Surg Endosc. https://doi.org/10.1007/s00464-018-6360-4

    Article  PubMed  Google Scholar 

  31. Koedam TWA, Veltcamp Helbach M, van de Ven PM, Kruyt PM, van Heek NT, Bonjer HJ, Tuynman JB, Sietses C (2018) Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol 22:279–287

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cedars Sinai Medical Center, 8737 Beverly Blvd. Suite 101, Los Angeles, CA, 90048, USA

    K. Zaghiyan & P. Fleshner

  2. St Mark’s Hospital, London, UK

    J. Warusavitarne

  3. Department of Surgery and Cancer Imperial College, London, UK

    J. Warusavitarne

  4. Humanitas Hospital, Milan, Italy

    A. Spinelli & F. Di Candido

  5. University of Kelaniya, Kelaniya, Sri Lanka

    P. Chandrasinghe

Authors
  1. K. Zaghiyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Warusavitarne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Chandrasinghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Di Candido
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Fleshner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Zaghiyan.

Ethics declarations

Conflict of interest

PF—teaching honorarium from Applied Medical, Inc. AS—teaching honorarium from Applied Medical, Inc. KZ—financial assistance for course attendance from Applied Medical, Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from patients across the sites.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaghiyan, K., Warusavitarne, J., Spinelli, A. et al. Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents. Tech Coloproctol 22, 867–873 (2018). https://doi.org/10.1007/s10151-018-1889-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-018-1889-8

Keywords

Search

Navigation