QS204 - Functional Outcomes of Transanal Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients: Inverse-Probability Weighting Analysis of a Single Centre Cohort

Purpose/Background: Laparoscopic proctocolectomy with ileal pouch-anal anastomosis (tabd-IPAA) is the standard approach for the surgical treatment of ulcerative colitis (UC). More recently, the transanal IPAA (ta-IPAA) has further reduced surgical trauma while offering better access for deep pelvic dissection, thereby allowing for enhanced recovery and lowering conversion rates to open surgery. Ta-IPAA requires the introduction of a transanal port through the anus to create access to the pelvis, resulting in dilatation of the anus during surgery. There is some concern about the impact of ta-IPAA on postoperative functional outcome. This study aims to compare the functional outcomes in patients having undergone tabd-IPAA and ta-IPAA.

Methods/Interventions: Patients with UC who underwent either tabd-IPAA or ta-IPAA at Mount Sinai Hospital between 2012-2022, and were at least 6 months after ileostomy reversal, were invited to complete a survey to assess functional outcome. Patients with colorectal cancer, a hand-sewn anastomosis, or pouch failure were excluded. The survey included the Colorectal Function Outcome (COREFO), International Prostate Symptom Score (IPSS), Patient-Reported Outcomes Measurement Information System (PROMIS) SexFS, and PROMIS Global-10, to assess pouch function, urinary function, sexual function, and overall quality of life, respectively. Chart review was performed for baseline demographics. Propensity score model (PSM) with inverse-probability weighting (IPW) was used to account for 4 preselected confounders.

Results/Outcomes: Sixty patients (29 males; median age = 34.6, IQR = 25.3-46.5) with tabd-IPAA and 26 (17 males; median age = 34.8, IQR = 26.9-51.9) with ta-IPAA completed the survey. There were no significant differences in age (p = 0.50), gender (p = 0.16), BMI (p = 0.20), and primary sclerosing cholangitis (p = 0.57) between the groups. More ta-IPAA patients underwent a modified 2-stage IPAA, avoiding a post-IPAA ileostomy (26.9% vs. 6.7%; p = 0.018). After inverse probability weighting using a propensity score model, the confounders were balanced between the weighted groups. In the IPW groups, there were no significant differences in colorectal function (p = 0.42), urinary function (p = 0.23), male sexual function (p = 0.18), and overall quality of life (p = 0.22) between the two groups. However, female patients who underwent ta-IPAA reported significantly better sexual function (average score difference 9.1, 95% CI 1.1-17.1; p = 0.027). On subgroup analysis of sexual function, difference in female satisfaction was detected, favouring the ta-IPAA group (average score difference 0.8, CI 0.0034-1.7; p = 0.049). There were no differences in interest in sexual activity, lubrication, vaginal discomfort, and orgasm.

Conclusion/Discussion: Functional outcome of patients undergoing IPAA surgery was not harmed by transanal access. In fact, females undergoing ta-IPAA reported a better sexual function, mainly due to improved satisfaction.