LATA-IBD Trial; A controlled feasibility study for the introduction of transanal minimally invasive IPAA-surgery
Bjarne Melvås, Jonas Bengtsson, Lars Börjesson, Maria Hermanson, Charlotta Larsson, Georgios Gialamoudis, Hanna de la CroixAbstract
Introduction
Laparoscopic Ileal pouch-anal anastomosis (lap-IPAA) has been associated with improved short-term outcomes, although postoperative complications and pouch function appear comparable to open IPAA. Transanal IPAA (ta-IPAA) may further improve outcomes by facilitating technically challenging steps, including pelvic dissection and ileoanal anastomosis. This study aimed to evaluate the feasibility of implementing ta-IPAA at a single center in comparison with prior experience of lap-IPAA, including assessment of pouch function.
Methods
This prospective cohort study included 22 patients who underwent ta-IPAA between 2018 and 2020, with two years follow-up. A historical cohort of 17 patients who underwent lap-IPAA between 2015 and 2016 served as control group. Primary outcomes were conversion to open surgery and anastomotic leakage. Secondary outcomes included operative time, blood loss, complications, reoperations, readmissions, length of hospital stay, and pouch function.
Results
Conversion rates were similar between groups (14% ta-IPAA versus 12% lap-IPAA). Anastomotic leakage occurred in 9% of ta-IPAA cases and 12% of lap-IPAA cases. Operative time and blood loss were greater in the ta-IPAA group. Complications were less frequent after ta-IPAA at 30 days (CCI 6 versus 22; P = 0.0056) and at two-years after surgery (CCI 15 versus 28; P = 0.059). Median hospital stay was shorter after ta-IPAA (10 versus 13.5 days). Pouch function in the ta-IPAA group was comparable with previous institutional results, with median Öresland score of 6.5 and no pouch failures.
Discussion
Ta-IPAA was introduced without increased complications or technical failure. Postoperative outcomes were comparable or improved relative to lap-IPAA. Further studies are warranted to confirm these findings.