M102 - Minimally Invasive Proctectomy During IPAA Reconstruction Is Not Associated with Reduced Pouch Complications Compared to Open

Monday, June 3, 2024

11:38 AM – 11:44 AM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

Daniel Aryeh Metzger, MD

Resident
Weill Cornell Medicine
New York Presbyterian/Weill Cornell
New York, NY, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

AM

Andrea Mesiti, MD

Resident
New York Presbyterian Hospital Weill Cornell
New York, New York, United States

Disclosure information not submitted.
SL

Sarah Lee, M.D.

Resident
Weill Cornell Medicine
Roseville, California, United States

Disclosure information not submitted.
JJ

Josh Johnson, MD

Surgical resident
New York Presbyterian Hospital Weill Cornell Medical Center
New York, New York, United States

Disclosure information not submitted.
VV

Valery Vilchez, MD

Assistant Professor
University of California Irvine
University of California at Irvine
Irvine, California, United States

Disclosure information not submitted.
MM

Morgan Manasa, MD, MPH

Resident
University of California, Irvine
Irvine, California, United States

Disclosure information not submitted.
EH

Eun Kyeong Hwang, n/a

Medical Student
SUNY Downstate College of Medicine
Brooklyn, New York, United States

Disclosure information not submitted.
AH

Angela Hsu, MD

GI Fellow
UC Irvine
orange, California, United States

Disclosure information not submitted.
Mehraneh D. Jafari, MD (she/her/hers)

Associate Professor, Colorectal Surgery
Weill Cornell Medicine
Weill Cornell Medicine
New York, New York, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Alessio Pigazzi, MD PhD

Professor of Surgery
Weill Cornell Medicine
Weill Cornell Medicine
New York, NY, United States

Disclosure information not submitted.

Purpose/Background: There is limited data on pouch-related outcomes after minimally invasive proctectomy and ileal pouch anal anastomosis (MIS-IPAA). The aim of this study is to determine if MIS-IPAA is associated with differences in postoperative outcomes and pouch complications compared to open surgery. Additionally, we aim to identify patient and disease factors associated with risk of long-term pouch complications.

Methods/Interventions: A retrospective review of patients who underwent IPAA for inflammatory bowel disease was conducted at two independent academic institutions from 2008-2021. Subjects were categorized based on surgical approach for proctectomy: open or MIS (laparoscopic or robotic) and outcomes were compared using Chi-squared test, Wilcoxon rank sum test, or Fisher’s exact as appropriate. Associations between study variables and risk of pouch complications were then assessed using logistic regression.

Results/Outcomes: Of the 144 patients analyzed, 34% (49/144) underwent MIS-IPAA –15 laparoscopic and 34 robotic - and 66% (95/144) underwent open surgery. Demographic and disease characteristics were similar between the MIS-IPAA and open surgery groups. There was no difference in intraoperative complications or 30-day postoperative complications. 97.2% (139/144) of patients underwent pouchoscopy 1 year postoperatively. There was no difference in pouch complications between MIS and open. At one year, the overall rate of pouchitis was 56.9% (Open - 56.8%, MIS - 57.1%; p-0.78), cuffitis was 23.8% (Open - 22.3%, MIS - 26.5%; p-0.66). The rate of pouch failure was 7.4% (Open - 7.7%, MIS - 6.7%; p-0.83) with an average time to failure of 48.2 months. Length of stay (MIS - 5.9d vs Open - 7.7d; p-0.027) and time to ostomy reversal (MIS – 90d vs Open – 118d; p-0.013) were significantly shorter in the MIS group compared to open.
Factors associated with increased risk of either pouchitis or cuffitis included >4 daily bowel movements preoperatively (p < 0.001), emergent indication for colectomy (OR 3.03, 95% CI 1.07-10.9; p-0.04), and BMI < 20 at time of surgery (OR 3.92, 95% CI 1.39-14.1; p-0.028) . Age >35 at surgery (p-0.35) and preoperative medical therapy(p-0.004) were associated with a decreased risk of pouchitis or cuffitis.

Conclusion/Discussion: MIS-IPAA is associated with a decreased postoperative length of stay and time diverted, as well as equivalent intraoperative and postoperative complications. However, there is no decrease in long-term pouch complications or pouch failure with the MIS approach. Patient and disease factors, but not operative factors, were associated with risk of long-term pouch complications.