Department of Surgery, Hospital Clinic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, New York, NY, USA.
Surg Endosc. 2019 May;33(5):1368-1375. doi: 10.1007/s00464-019-06674-5. Epub 2019 Jan 23.
The transanal approach to pelvic dissection has gained considerable traction and utilization continues to expand, fueled by the transanal total mesorectal excision (TaTME) for rectal cancer. The same principles and benefits of transanal pelvic dissection may apply to the transanal restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA)-the TaPouch procedure. Our goal was to review the literature to date on the development and current state of the TaPouch.
We performed a PubMed database search for original articles on transanal pelvic dissections, IPAA, and the TaPouch procedure, with a manual search from relevant citations in the reference list. The main outcomes were the technical aspects of the TaPouch, clinical and functional outcomes, and potential advantages, drawbacks, and future direction for the procedure.
The conduct of the procedure has been defined, with the safety and feasibility demonstrated in small series. The reported rates of conversion and anastomotic leakage are low. There are no randomized trials or large-scale comparative studies available for comparative effectiveness compared to the traditional IPAA.
The transanal approach to ileal pouch-anal anastomosis is an exciting adaption of the transanal total mesorectal excision for refining the technical steps of a complex operation. Additional experience is needed for comparative outcomes and defining the ideal training and implementation pathways.
经肛门入路进行盆腔解剖术式得到了广泛关注，并且随着经肛门全直肠系膜切除术（TaTME）在直肠癌中的应用不断扩大，该术式的应用也在不断增加。同样的经肛门盆腔解剖术式的原理和优势也可能适用于经肛门直肠切除吻合术加回肠储袋肛管吻合术（IPAA）-TaPouch 手术。我们的目的是回顾目前关于 TaPouch 手术发展和现状的文献。
我们对经肛门盆腔解剖术式、IPAA 和 TaPouch 手术的原始文章进行了 PubMed 数据库检索，并从参考文献中手动搜索相关引文。主要结果是 TaPouch 手术的技术方面、临床和功能结果以及该手术的潜在优势、缺点和未来方向。
该手术的操作方法已经确定，在小系列研究中证明了其安全性和可行性。报告的转化率和吻合口漏的发生率较低。与传统的 IPAA 相比，目前尚无随机试验或大规模的比较研究来评估其比较效果。
经肛门入路行回肠储袋肛管吻合术是 TaTME 术式的一种令人兴奋的改进，它可以细化复杂手术的技术步骤。需要更多的经验来比较结果，并确定理想的培训和实施途径。
