Controversies in IPAA for Ulcerative Colitis: A Systematic Review of Different Anastomotic Techniques.
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
01 Jun 2024
01 Jun 2024
Historique:
medline:
7
5
2024
pubmed:
7
5
2024
entrez:
6
5
2024
Statut:
ppublish
Résumé
Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques. To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy. Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis. IPAA technique. Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function). Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques. A low number of studies with handsewn IPAA technique and a large number of studies added at authors' discretion were the limitations of this strudy. Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.
Sections du résumé
BACKGROUND
BACKGROUND
Available techniques for IPAA in ulcerative colitis include handsewn, double-stapled, and single-stapled anastomoses. There are controversies, indications, and different outcomes regarding these techniques.
OBJECTIVE
OBJECTIVE
To describe technical details, indications, and outcomes of 3 specific types of anastomoses in restorative proctocolectomy.
DATA SOURCE
METHODS
Systematic literature review for articles in the PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
STUDY SELECTION
METHODS
Studies describing outcomes of the 3 different types of anastomoses, during pouch surgery, in patients undergoing restorative proctocolectomy for ulcerative colitis.
INTERVENTION
METHODS
IPAA technique.
MAIN OUTCOME MEASURES
METHODS
Postoperative outcomes (anastomotic leaks, overall complication rates, and pouch function).
RESULTS
RESULTS
Twenty-one studies were initially included: 6 studies exclusively on single-stapled IPAA, 2 exclusively on double-stapled IPAA, 6 studies comparing single-stapled to double-stapled techniques, 6 comparing double-stapled to handsewn IPAA, and 1 comprising single-stapled to handsewn IPAA. Thirty-seven studies were added according to authors' discretion as complementary evidence. Between 1990 and 2015, most studies were related to double-stapled IPAA, either only analyzing the results of this technique or comparing it with the handsewn technique. Studies published after 2015 were mostly related to transanal approaches to proctectomy for IPAA, in which a single-stapled anastomosis was introduced instead of the double-stapled anastomosis, with some studies comparing both techniques.
LIMITATIONS
CONCLUSIONS
A low number of studies with handsewn IPAA technique and a large number of studies added at authors' discretion were the limitations of this strudy.
CONCLUSIONS
CONCLUSIONS
Handsewn IPAA should be considered if a mucosectomy is performed for dysplasia or cancer in the low rectum or, possibly, for re-do surgery. Double-stapled IPAA has been more widely adopted for its simplicity and for the advantage of preserving the anal transition zone, having lower complications, and having adequate pouch function. The single-stapled IPAA offers a more natural design, is feasible, and is associated with reasonable outcomes compared to double-stapled anastomosis. See video from symposium.
Identifiants
pubmed: 38710588
doi: 10.1097/DCR.0000000000003292
pii: 00003453-202406001-00003
doi:
Banques de données
ClinicalTrials.gov
['NCTIon tria']
Types de publication
Journal Article
Systematic Review
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
S26-S35Informations de copyright
Copyright © The ASCRS 2024.
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