Dig Liver Dis. 2024 Oct 8:S1590-8658(24)01012-0. doi: 10.1016/j.dld.2024.09.013.Online ahead of print.

Michela Mineccia ¹, Alessandro Ferrero ², Matteo Rottoli ³, Antonino Spinelli ⁴, Luigi Sofo ⁵, Giampaolo Ugolini ⁶, Giuliano Barugola ⁷, Giacomo Ruffo ⁸, Andrea Braini ⁹, Gaetano Luglio ¹⁰, Giuseppe Sica ¹¹, Gianluca M Sampietro ¹²; ICON FUN study group

Collaborators

ICON FUN study group: 

Paolo Massucco ¹³, Federico Fazio ¹³, Serena Perotti ¹³, Giovanni Castagna ¹⁴, Benedetta Petrello ¹⁴, Elena Brusa ¹⁴, Argentina Tiano ¹⁴, Giacomo Calini ¹⁴, Tommaso Violante ¹⁴, Stefano Cardelli ¹⁴, Michele Carvello ¹⁵, Stefano De Zanet ¹⁵, Nicolas Avellaneda ¹⁶, Franco Sacchetti ¹⁷, Mauro Giambusso ¹⁷, Federico Mazzotti ¹⁸, Isacco Montroni ¹⁸, Federico Ghignone ¹⁸, Nicola Cracco ¹⁹, Angela Variola ²⁰, Alessia Todeschini ²⁰, Francesco Tumminelli ²¹, Antonio Miele ²², Francesca Tropeano ²², Michele Cricri ²², Brunella Pirozzi ²³, Valeria Usai ²³, Caterina Baldi ²⁴, Carlo Alberto Manzo ²⁴

Author information

¹Department of General and Oncologic Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Torino, Italy. Electronic address: mmineccia@mauriziano.it.

²Department of General and Oncologic Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Torino, Italy.

³Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.

⁴Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.

⁵Depertment of Colorectal Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS Università' Cattolica S. Cuore, Roma, Italy.

⁶Colorectal? and General Surgery, Ospedale Santa Maria delle Croci, Viale Randi, 5, 48121, Ravenna, Italy.

⁷Department of General Surgery, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy; Department of IBD Unit, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy.

⁸Department of General Surgery, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy.

⁹Department of General Surgery, Ospedale di Pordenone, ASFO, Via Montereale 24, Pordenone, Italy.

¹⁰University of Naples, Federico II, Via Pansini 5, Napoli, Italy.

¹¹Departement of Minimally Invasive Surgery, Department of Surgery. Università e Policlinico Tor Vergata. Torvergata, Rome, Italy.

¹²Department of Surgery, ASST Rhodense. Ospedale di Rho, Monumento ai Caduti. Corso Europa, 250, 20017, Rho, Milano, Italy.

¹³Department? of General and Oncologic Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Torino, Italy.

¹⁴Surgery? of the Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria di Bologna, Italy; Department? of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.

¹⁵Department? of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS? Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.

¹⁶Department? of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS? Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; General? Surgery Department, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Argentina.

¹⁷Depertment? of Colorectal Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS Università' Cattolica S. Cuore, Roma, Italy.

¹⁸Colorectal and General Surgery, Ospedale Santa Maria delle Croci, Viale Randi, 5, 48121, Ravenna, Italy.

¹⁹Department? of General Surgery, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy; Department? of IBD Unit, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy.

²⁰Department? of IBD Unit, IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Verona, Italy.

²¹Department? of General Surgery, Ospedale di Pordenone, ASFO, Via Montereale 24, Pordenone, Italy.

²²University? of Naples, Federico II, Via Pansini 5, Napoli, Italy.

²³Departement? of Minimally Invasive Surgery, Department of Surgery. Università e Policlinico Tor Vergata. Torvergata, Rome, Italy.

²⁴Department? of Surgery, ASST Rhodense. Ospedale di Rho, Monumento ai Caduti. Corso Europa, 250, 20017, Rho, Milano, Italy.

Abstract

Background: Available guidelines lack in indications on surgical standard in Ulcerative Colitis (UC) AIMS: To determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. The secondary aims consisted of perioperative outcomes and complications.

Methods: Data on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological Low-Anterior-Resection-Syndrome (LARS) score.

Results: Mesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. Laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). Mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). Hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). The Transanal-Transection and Single-Stapling Anastomosis (TTSS) showed to be protective against pouchitis. Extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057).

Conclusions: The study highlights advantages of laparoscopy. New techniques such as TTSS promise further improvements. Mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.