Functional outcomes of transanal ileal pouch anal anastomosis in patients with ulcerative colitis: inverse-probability weighing analysis of a single-center cohort

Abstract

Purpose: This single-center, comparative cohort study aimed to compare the functional outcomes between patients who have undergone laparoscopic ileal pouch-anal anastomosis (lap-IPAA) and those who have undergone transanal ileal pouch-anal anastomosis (ta-IPAA).

Methods: Patients with ulcerative colitis who underwent IPAA at Mount Sinai Hospital between 2012 and 2022 and were at least 6 months after ileostomy reversal were invited to complete a survey. Patients with colorectal cancer, a handsewn anastomosis, anastomotic leak, or pouch failure were excluded. Questionnaires, including the Colorectal Functional Outcome, International Prostate Symptom Score, Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction, and PROMIS Global-10, were submitted to participants to assess pouch function, urinary function, sexual function, and overall quality of life (QOL), respectively. A retrospective chart review was performed for baseline demographics and clinical data. A propensity score model with inverse probability weighting analysis was performed.

Results: A total of 85 patients (median age of 34.7 years; 54.1% male), of whom 59 underwent lap-IPAA and 26 underwent ta-IPAA, participated in the study. There were no significant differences in sex, age, smoking status, primary sclerosing cholangitis diagnosis, and diabetes mellitus between the groups. There were no significant differences in either overall Colorectal Functional Outcome score (difference in score of -3.0 [95% CI, -11.0 to 4.8]; P =.45) or its domains (incontinence, social effect, frequency, stool-related aspects, and need for medication). In addition, urinary function, male sexual function, and overall QOL were comparable between the 2 groups.

Conclusion: The functional outcomes of patients who undergo IPAA are not harmed by transanal access.

Keywords: Bowel function; Ileal pouch-anal anastomosis; Laparoscopic ileal pouch-anal anastomosis; Pouch function; Transanal ileal pouch-anal anastomosis.