"Near-TME": proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis

Female near-TME: standardization of proctectomy in women with ulcerative colitis

Traditionally, 2 surgical techniques for proctectomy in ulcerative colitis have been used: total mesorectal excision (TME), and close rectal dissection (CRD). Recently, our research group has proposed the standardization of the Near-TME technique, which unites the advantages of both methods. It decreases the risk of pelvic autonomic nerve injury and reduces the volume of mesorectal remnant. When performing the Near-TME, the anatomical landmarks differ between men and women, especially in the anterolateral hemicircumference. The objective of this paper is to standardize the Near-TME technique in women (Female Near-TME) using characteristic surgical-anatomic landmarks of the female pelvis based on illustrations and a real case treated laparoscopically. This technique should be carried out by surgeons with experience in inflammatory bowel disease surgery and extensive knowledge of surgical anatomy.

Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis

BACKGROUND

During ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), rectal dissection can be performed via close rectal dissection (CRD) or in a total mesorectal excision plane (TME). Although CRD should protect autonomic nerve function, this technique may be more challenging than TME. The aim of this study was to compare long-term outcomes of patients undergoing CRD and TME.

METHODS

This single-centre retrospective cohort study included consecutive patients who underwent IPAA surgery for UC between January 2002 and October 2017. Primary outcomes were chronic pouch failure (PF) among patients who underwent CRD and TME and the association between CRD and developing chronic PF. Chronic PF was defined as a pouch-related complication occurring ≥ 3 months after primary IPAA surgery requiring redo pouch surgery, pouch excision or permanent defunctioning ileostomy. Secondary outcomes were risk factors and causes for chronic PF. Pouch function and quality of life were assessed via the Pouch dysfunction score and Cleveland global quality of life score.

RESULTS

Out of 289 patients (155 males, median age 37 years [interquartile range 26.5-45.5 years]), 128 underwent CRD. There was a shorter median postoperative follow-up for CRD patients than for TME patients (3.7 vs 10.9 years, p < 0.01). Chronic PF occurred in 6 (4.7%) CRD patients and 20 (12.4%) TME patients. The failure-free pouch survival rate 3 years after IPAA surgery was comparable among CRD and TME patients (96.1% vs. 93.5%, p = 0.5). CRD was a no predictor for developing chronic PF on univariate analyses (HR 0.7 CI-95 0.3-2.0, p = 0.54). A lower proportion of CRD patients developed chronic PF due to a septic cause (1% vs 6%, p = 0.03).

CONCLUSIONS

Although differences in chronic PF among CRD and TME patients were not observed, a trend toward TME patients developing chronic pelvic sepsis was detected. Surgeons may consider performing CRD during IPAA surgery for UC.