Transanal minimally invasive proctectomy for ulcerative colitis is beneficial in terms of short-term outcomes and defecation function

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2024-07-14 DOI:10.1002/ags3.12844
Marie Hanaoka, Yusuke Kinugasa, Kenta Yao, Ayumi Takaoka, Megumi Sasaki, Shinichi Yamauchi, Masanori Tokunaga
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Abstract

Objective

Despite being reported safety, the advantages of transanal minimally invasive proctocolectomy (TAMIP) are controversial, and comparative studies on postoperative defecation function between ileal pouch-anal anastomosis (IPAA) using laparoscopic transanal manipulation (TAMIP-IPAA) and without this technique (traditional IPAA) are lacking. This study analyzed TAMIP's impact on short-term and postoperative defecation function in patients with ulcerative colitis (UC) to evaluate its safety and feasibility.

Methods

Inclusion criteria comprised patients with UC undergoing minimally invasive proctocolectomy at our hospital from May 2014 to May 2023. The TAMIP-IPAA approach involved precise rectal mucosa removal while preserving the sphincter muscle during laparoscopic transanal manipulation.

Results

In the evaluation of short-term outcomes for 71 patients undergoing proctocolectomy, the TAMIP group (37 patients) outperformed the non-TAMIP group in operative time (395 vs. 289 min, p < 0.001) and postoperative hospital stay (12 vs. 8 days, p < 0.001). Additionally, TAMIP-IPAA demonstrated advantages over traditional IPAA (seven patients), in operative time (443 vs. 289 min, p = 0.006), intraoperative blood loss (392 vs. 130 mL, p = 0.001), postoperative hospital stay (18 vs. 8 days, p = 0.003), anastomotic leakage (42.9% vs. 8.1%, p = 0.041), and re-admission within 30 days (57.1% vs. 8.1%, p = 0.009). Wexner scores were significantly superior in the TAMIP-IPAA group at 6 months (14.5 vs. 8.0 points, p = 0.029) and 1 year post stoma closure (14.0 vs. 7.0 points, p = 0.020), indicating enhanced short-term outcomes and defecation function compared to traditional IPAA.

Conclusions

TAMIP-IPAA for UC has the potential to offer promising benefits, including the enhancement of short-term outcomes and the improvement of defecation function.

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经肛门微创直肠切除术治疗溃疡性结肠炎对短期疗效和排便功能有益
尽管经肛门微创直肠切除术(TAMIP)的安全性已得到报道,但其优势仍存在争议,而且目前还缺乏对使用腹腔镜经肛门操作的回肠袋-肛门吻合术(IPAA)(TAMIP-IPAA)和不使用该技术的回肠袋-肛门吻合术(传统IPAA)术后排便功能的比较研究。本研究分析了TAMIP对溃疡性结肠炎(UC)患者短期和术后排便功能的影响,以评估其安全性和可行性。纳入标准包括2014年5月至2023年5月在我院接受微创直肠结肠切除术的UC患者。TAMIP-IPAA方法包括在腹腔镜经肛门操作中精确切除直肠粘膜,同时保留括约肌。在对71名接受直肠切除术的患者进行短期疗效评估时,TAMIP组(37名患者)在手术时间(395分钟对289分钟,P<0.001)和术后住院时间(12天对8天,P<0.001)方面优于非TAMIP组。此外,TAMIP-IPAA 在手术时间(443 分钟对 289 分钟,p = 0.006)、术中失血(392 毫升对 130 毫升,p = 0.001)、术后住院时间(18 天对 8 天,p = 0.003)、吻合口漏(42.9% 对 8.1%,p = 0.041)和 30 天内再次入院(57.1% 对 8.1%,p = 0.009)方面均优于传统的 IPAA(7 例患者)。TAMIP-IPAA组在造口关闭后6个月(14.5分 vs. 8.0分,p = 0.029)和1年(14.0分 vs. 7.0分,p = 0.020)的Wexner评分明显优于传统IPAA组,表明短期疗效和排便功能均优于传统IPAA组。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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