Violante Tommaso, Broccard Sacha P, Novelli Marco, Stocchi Luca, Colibaseanu Dorin T, DeLeon Michelle F, Behm Kevin T, Mishra Nitin, Larson David W, Merchea Amit
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
School of General Surgery, Bologna University, Bologna, Italy.
BJS Open. 2025 Jul 1;9(4). doi: 10.1093/bjsopen/zraf084.
Ileal pouch-anal anastomosis (IPAA) is a common surgical procedure for patients with ulcerative colitis or familial adenomatous polyposis. This study compared the outcomes of robotic, laparoscopic, and open IPAA techniques, with a focus on surgical complications and pouch failure rates.
A retrospective study was conducted of patients who underwent IPAA at three Mayo Clinic locations between 2015 and 2020. Data on patient demographics, surgical details, and postoperative outcomes were collected and compared across the three surgical approaches. Pouch failure was defined as the need for pouch excision or a diverting loop ileostomy.
In all, 401 patients underwent IPAA with either an open (149, 37.2%), robotic (145, 36.2%), or laparoscopic (107, 26.7%) technique. The overall rate of pouch failure was 6.5% and did not differ significantly between the three surgical approaches. Compared with laparoscopy, robotic IPAA was associated with a lower conversion rate to open surgery (1.4 versus 17.8%; P < 0.0001) and fewer 30-day readmissions (15.9% versus 28.0%; P = 0.02). However, robotic and laparoscopic IPAA approaches had higher rates of venous thromboembolism/pulmonary embolism and readmission than the open approach. Pouchitis was the most common cause of pouch failure across all surgical techniques.
Robotic IPAA had lower conversion and reduced 30-day admission rates compared with a laparoscopic approach. However, open surgery had lower rates of 30-day readmission and rates thromboembolism than robotic IPAA. The surgical approach itself does not appear to significantly impact long-term pouch failure rates.
回肠储袋肛管吻合术（IPAA）是溃疡性结肠炎或家族性腺瘤性息肉病患者常见的外科手术方法。本研究比较了机器人辅助、腹腔镜和开放IPAA技术的手术效果，重点关注手术并发症和储袋失败率。
对2015年至2020年间在梅奥诊所三个地点接受IPAA手术的患者进行回顾性研究。收集患者人口统计学数据、手术细节和术后结果，并在三种手术方式之间进行比较。储袋失败定义为需要进行储袋切除或转流性回肠造口术。
共有401例患者接受了IPAA手术，手术方式分别为开放手术（149例，37.2%）、机器人辅助手术（145例，36.2%）或腹腔镜手术（107例，26.7%）。总体储袋失败率为6.5%，三种手术方式之间无显著差异。与腹腔镜手术相比，机器人辅助IPAA手术转为开放手术的比例较低（1.4%对17.8%；P<0.0001），30天再入院率也较低（15.9%对28.0%；P=0.02）。然而，机器人辅助和腹腔镜IPAA手术的静脉血栓栓塞/肺栓塞发生率和再入院率高于开放手术。在所有手术技术中，袋炎是储袋失败最常见的原因。
与腹腔镜手术相比，机器人辅助IPAA手术的中转率较低，30天入院率也有所降低。然而，开放手术的30天再入院率和血栓栓塞发生率低于机器人辅助IPAA手术。手术方式本身似乎对长期储袋失败率没有显著影响。
