Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study.

Autor: Chandrasinghe P; Department of Surgery and Cancer, Imperial College, London, UK.; Department of Colorectal Surgery, St. Mark's Hospital, Harrow, UK.; Department of Surgery, Faculty of Medicine, University of Kelaniya, Sri Lanka., Carvello M; Colon and Rectal Surgery Division, Humanitas Clinical and Research Hospital, Milan, Italy., Wasmann K; Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands., Foppa C; Department of Biomedical Science, Humanitas Research Hospital, Milan, Italy., Tanis P; Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands., Perry-Woodford Z; Department of Colorectal Surgery, St. Mark's Hospital, Harrow, UK., Warusavitarne J; Department of Surgery and Cancer, Imperial College, London, UK.; Department of Colorectal Surgery, St. Mark's Hospital, Harrow, UK., Spinelli A; Colon and Rectal Surgery Division, Humanitas Clinical and Research Hospital, Milan, Italy.; Department of Biomedical Science, Humanitas Research Hospital, Milan, Italy., Bemelman W; Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of Crohn's & colitis [J Crohns Colitis] 2020 Jul 09; Vol. 14 (6), pp. 726-733.
DOI: 10.1093/ecco-jcc/jjz174
Abstrakt: Background: The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC.
Methods: A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point.
Results: A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09].
Conclusions: This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.
(Copyright © 2019 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje