Systemic Acute-phase Response in Laparoscopic and Open Ileal Pouch Anal Anastomosis in Patients With Ulcerative Colitis: A Case-matched Comparative Study. Surg Laparosc Endosc Percutan Tech. 2015;25:424-429. [PMID: 25730740 DOI: 10.1097/sle.0000000000000128]

Surgical trend including minimally invasive surgeries for ulcerative colitis in the COSUC study: the largest multicenter cohort study in Japan

BACKGROUND

The number of patients with ulcerative colitis (UC) is increasing rapidly in Asia. No large study has evaluated the clinical outcomes of hand-sewn ileal pouch-anal anastomosis (IPAA). This study aimed to create a large database of the surgical outcomes of UC, present the trends of surgical procedures, and evaluate the impact of minimally invasive procedures on UC.

METHODS

Data of patients first treated from 2005 to 2019 were collected; two-staged surgery data were extracted, and minimally invasive surgery (MIS) and open surgery (OS) outcomes were compared using propensity-score matching.

RESULTS

The data of 1558 cases were selected as the main analysis set. The number of surgical cases of UC has been increasing, with increasing proportion of MIS cases (2005: 43%, 2019: 84%). The median age of the patients increased in these 15 years (39.5-56 years old). Of 873 patients who underwent two-staged surgery, after 3:1 matching, 408 MIS and 176 OS cases were compared. Hand-sewn anastomoses were performed in 293 MIS (72.0%) and 142 OS-IPAA (80.7%) cases. The proportion of early complications (≥ Grade 3) did not vary between the two groups. Intraoperative blood loss was lower and blood transfusions were less frequent in the MIS group.

CONCLUSIONS

The proportion of MIS for UC has rapidly increased over the past 15 years. The total number of MIS and OS complications did not vary significantly between the groups. The short-term advantages of MIS include reduced blood loss and less necessity for blood transfusions.

Patient-reported Outcome Measures in Ileoanal Pouch Surgery: a Systematic Review

OBJECTIVE

To summarise frequency, type, and heterogeneity of patient-reported outcomes measures [PROMs] in papers reporting on outcomes after ileal pouch anal anastomosis [IPAA].

BACKGROUND

Prevalence of ulcerative colitis [UC] has risen in Western countries, and one in three patients requires surgery. IPAA is a frequently performed procedure for UC, and a lack of standardisation is manifest in reporting outcomes for inflammatory bowel disease [IBD] despite the clear need for inclusion of PROMs as primary outcomes in IBD trials.

METHODS

Scopus, Pubmed, and Web of Science databases were searched from January 2010 to January 2023 for studies investigating outcomes in IPAA surgery. The primary outcome was the proportion of studies reporting outcomes for IPAA surgery for UC, which included PROMs.

RESULTS

The search identified a total of 8028 studies which, after de-duplication and exclusion, were reduced to 79 articles assessing outcomes after IPAA surgery. In all 44 [55.7%] reported PROMs, with 23 including validated questionnaires and 21 papers using authors' questions, 22 different PROMs were identified, with bowel function as the most investigated item. The majority of studies [67/79, 85%] were retrospective, only 14/79 [18%] were prospective papers and only two were [2.5%] randomised, controlled trials.

CONCLUSIONS

Only half of the papers reviewed used PROMs. The main reported item is bowel function and urogenital, social, and psychological functions are the most neglected. There is lack of standardisation for use of PROMs in IPAA. Complexity of UC and of outcomes after IPAA demands a change in clinical practice and follow-up, given how crucial PROMs are, compared with their non-routine use.

Laparoscopic Versus Open Restorative Proctocolectomy for Familial Adenomatous Polyposis

PURPOSE

This study compared outcomes after laparoscopic (LAP) or conventional (open) total proctocolectomy with outcomes after ileal J-pouch anal anastomosis (IPAA) at a single institution.

METHODS

Charts from 133 familial adenomatous polyposis patients (1997-2013) were reviewed. Demographic data (age, sex, color, American Society of Anesthesiologists [ASA] status, previous surgery, and body mass index) and surgical outcomes (length of stay, early and late morbidity, reoperation, and mortality rates) were compared among 63 patients undergoing IPAA.

RESULTS

Demographic features were similar among patients (25 open and 38 LAP). Conversely, colorectal cancer at diagnosis prevailed in the open group (60% versus 31.6%; P = .02). Tumor stages (P = .65) and previous surgery index (20% versus 10.5%; P = .46) were similar. Surgical length was longer for LAP (374 versus 281 minutes, P = .003). Short-term complication rates (28% versus 28.9%), hospital stay (10.9 versus 8.9 days), and total long-term reoperations (28% versus 21%) were not statistically different. However, major late morbidity (16% versus 2.6%; P < .001) and late reoperation rates (16% versus 5.2%; P < .05) were greater among open patients. Both groups did not differ regarding pouch failure rates (8% versus 5.2%). There was no operative mortality in the present series.

CONCLUSIONS

(1) LAP IPAA is a safe procedure associated with a low conversion rate, (2) short-term results showed no clear advantages for both approaches, and (3) a greater risk of major late complications and late reoperations should be expected after open procedures.

溃疡性结肠炎的外科微创治疗

外科治疗是溃疡性结肠炎(ulcerative colitis, UC)的重要组成部分, 全结直肠切除、回肠贮袋肛管吻合术(ileal pouch-anal anastomosis, IPAA)已成为标准术式. 近年来在微创外科技术的迅猛发展与普及下, 越来越多医疗中心开展腹腔镜IPAA手术. 腹腔镜IPAA手术相比于开腹手术的在术后近、远期疗效中的优势逐渐突显, 且其安全有效性已达成共识. 目前更多更为微创的技术也陆续尝试应用于IPAA手术. 但是由于UC患者自身疾病的特点和IPAA术式的复杂性, 腹腔镜IPAA手术仍未达到标准化、规范化水平. 本文主要针对UC微创外科术后疗效和合理应用的研究进展作一述评.