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

Marie Hanaoka; Yusuke Kinugasa; Kenta Yao; Ayumi Takaoka; Megumi Sasaki; Shinichi Yamauchi; Masanori Tokunaga

doi:10.1002/ags3.12844

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

Ann Gastroenterol Surg. 2024 Jul 14;8(6):1056-1066. doi: 10.1002/ags3.12844. eCollection 2024 Nov.

Authors

Marie Hanaoka¹, Yusuke Kinugasa¹, Kenta Yao¹, Ayumi Takaoka¹, Megumi Sasaki¹, Shinichi Yamauchi¹, Masanori Tokunaga¹

Affiliation

¹ Department of Gastrointestinal Surgery Tokyo Medical and Dental University Bunkyo-ku Tokyo Japan.

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.

Keywords: defecation function; ileal pouch‐anal anastomosis; transanal minimally invasive proctectomy; ulcerative colitis.