Department of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Laparoendosc Adv Surg Tech A. 2021 Aug;31(8):898-904. doi: 10.1089/lap.2021.0115. Epub 2021 Jun 14.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis and select patients with Crohn's disease. Minimally invasive techniques have been increasingly adopted including the transanal approach. However there remains a dearth of comparative data assessing the technical advantages and outcomes of a transanal approach to the IPAA against other minimally invasive techniques. In this review, we describe our learned approach with the transanal IPAA (ta-IPAA) and highlight key technical steps for a successful surgery in addition to evaluating the current literature on surgical and functional outcomes of this relatively novel procedure. The ta-IPAA affords better visualization and access during a pelvic dissection translating to lower conversion rates. Lower odds of postoperative morbidity have been reported, but there was no difference in severity of complications when present. Though this technique has the advantages of a more accurate rectal transection obviating the need for multiple staple firings, the risk of anastomotic leak was similar between the two groups. Functional outcomes were found to be overall similar, though data is limited. The technical aspects of the IPAA have continued to evolve to mitigate the challenges posed by a deep pelvic dissection. While the ta-IPAA has been shown to be a safe and feasible procedure, the true advantages and functional benefits of this technique have yet to be elucidated with large-scale, quality data.
回肠贮袋肛管吻合术（IPAA）是溃疡性结肠炎和部分克罗恩病患者的首选治疗方法。微创技术越来越多地被采用，包括经肛途径。然而，对于经肛途径与其他微创技术相比在技术优势和手术结果方面的比较数据仍然缺乏。在这篇综述中，我们描述了我们经肛 IPAA（ta-IPAA）的经验，并强调了成功手术的关键技术步骤，此外还评估了该相对较新手术程序的手术和功能结果的现有文献。ta-IPAA 在骨盆解剖过程中提供了更好的可视化和进入途径，从而降低了转换率。据报道，术后发病率较低，但在存在并发症时，严重程度没有差异。虽然该技术具有更准确的直肠横断的优点，避免了多次吻合钉的需要，但吻合口漏的风险在两组之间相似。尽管功能结果总体相似，但数据有限。IPAA 的技术方面一直在不断发展，以减轻深部骨盆解剖带来的挑战。虽然 ta-IPAA 已被证明是一种安全且可行的手术，但该技术的真正优势和功能益处尚未通过大规模、高质量的数据来阐明。
