Rectal eversion: safe and effective way to achieve low transaction in minimally invasive Ileal pouch-anal anastomosis surgery, short- and long-term outcomes

Jose Cataneo, Peter Mowschenson, Thomas E. Cataldo, Vitaliy Poylin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Ileal pouch-anal anastomosis remains a gold standard in restoring continence in patient with ulcerative colitis. Achievinglow transection can be challenging and may require mucosectomy with a hand-sewn anastomosis. Rectal eversion (RE)technique provides a safe and effective alternative for both open and minimally invasive approaches. The purpose of thisstudy is to evaluate short- and long-term outcomes of patients who underwent RE when compared to those who underwentconventional trans-abdominal transection. Materials and methods: This is a retrospective review performed at tertiary care center. Patients undergoingproctectomy and pouch surgery by either standard approach or with RE from November 2004 to January 2017 wereevaluated. Demographics, post-operative complications, as well as 1- and 3-year functional outcomes were analyzed. Results: Total of176 underwent proctocolectomy with creation of a J pouch and 88 (50%) had the RE technique utilized. The RE group had ahigher rate of corticosteroid use at the time of surgery 59.1 versus 39.8% (p = 0.0156), but otherwise groups were statisticallysimilar. 20 cases (26.1%) of RE group and 54 (61%) of conventional group cases were accomplished in minimally invasivefashion. There was no difference in the rates of 30- and 90-day complications. Functional outcomes data were available forup to 78.4% of patient with trans-abdominal approach and 64.7% in RE group. At 1 and 3 years after surgery, there was nodifference in the number of bowel movements, fecal incontinence, or nocturnal bowel movements. The rates of returning toileostomy or pouch revision were the same. Conclusion: RE technique is safe and effective way to achieve a low transaction in J pouchsurgery. The technique provides similar functional outcomes at 1 and 3 years after surgery and can be particularly useful inminimally invasive approaches.

Original languageEnglish (US)
Pages (from-to)1290-1293
Number of pages4
JournalSurgical endoscopy
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • Ileal pouch-anal anastomosis
  • Low pelvic transection
  • Rectal eversion

ASJC Scopus subject areas

  • Surgery

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