Academic Journal
Προβολή σε EDS
Συνδεδεμένο Πλήρες Κείμενο

A systematic review on surgical trends after ileal pouch-anal anastomosis for inflammatory bowel disease: shifting the focus from traditional to minimally invasive approaches.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: A systematic review on surgical trends after ileal pouch-anal anastomosis for inflammatory bowel disease: shifting the focus from traditional to minimally invasive approaches.
Συγγραφείς: Gallo G; Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy. gallo.gaetano@hsr.it., Agnesi S; Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy., Danese S; Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy., Vignali A; Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy., Sileri P; Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
Συλλογικό Έργο: Ileal Pouch-Anal Anastomosis Working Group
Πηγή: Updates in surgery [Updates Surg] 2026 Aug; Vol. 78 (4), pp. 1489-1499. Date of Electronic Publication: 2026 Feb 16.
Τύπος έκδοσης: Systematic Review; Journal Article; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 101539818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2038-3312 (Electronic) Linking ISSN: 2038131X NLM ISO Abbreviation: Updates Surg Subsets: MEDLINE
Imprint Name(s): Original Publication: Milano : Springer-Verlag Italia
Ιατρικοί όροι (MeSH): Proctocolectomy, Restorative*/methods , Proctocolectomy, Restorative*/trends , Minimally Invasive Surgical Procedures*/trends , Minimally Invasive Surgical Procedures*/methods , Inflammatory Bowel Diseases*/surgery , Laparoscopy*/trends , Laparoscopy*/methods , Colonic Pouches*, Anastomosis, Surgical/methods ; Anastomosis, Surgical/trends ; Humans ; Treatment Outcome
Περίληψη: Ileal pouch-anal anastomosis (IPAA) has been the preferred surgical treatment for selected patients with inflammatory bowel disease (IBD) since its introduction in 1978. Over the past 3 decades, significant advances have occurred, particularly with the evolution of minimally invasive surgical techniques. This systematic review aimed to analyze surgical outcomes following IPAA over the last 30 years, focusing on the transition from open to minimally invasive approaches. A comprehensive search was conducted in PubMed, Embase, and Web of Science, yielding 46,024 articles. Studies were categorized into three time periods: Group A (1980-1999), Group B (2000-2009), and Group C (2010-2025). The review was registered in PROSPERO (CRD42024604869). Twenty studies published between 1981 and 2018 were included, encompassing a total of 5474 patients. Group A comprised 3903 patients (71.3%), Group B 1312 (24.0%), and Group C 259 (4.7%). Use of laparoscopic approaches increased substantially over time: 11.9% in Group A, 26.2% in Group B, and 54.4% in Group C. Conversely, the rate of diverting loop ileostomy decreased from 88.6% in Group A to 69.9% in Group B and 23.8% in Group C. The proportion of patients undergoing concomitant proctocolectomy at the time of IPAA declined markedly from 93.1% (Group A) to 38.4% (Group B) and 22% (Group C). Length of hospital stay progressively decreased, with mean durations of 11.9 ± 2.6 days, 11.0 ± 5.4 days, and 7.8 ± 2.7 days in Groups A, B, and C, respectively. Postoperative complication rates also declined significantly: 86.7% in Group A, 66.8% in Group B, and 37.8% in Group C. Over the last three decades, surgical outcomes following IPAA for IBD have markedly improved. This improvement coincides with an increased use of minimally invasive techniques and a shift toward staged surgical approaches.
(© 2026. Italian Society of Surgery (SIC).)
Competing Interests: Declarations. Conflict of interest: The authors have no conflict of interest to declare. Ethical approval: Not required. Informed consent: Not required.
References: Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88. (PMID: 10.1136/bmj.2.6130.856675721605901)
Lee KE, Faye AS, Vermeire S, Shen B (2022) Perioperative management of ulcerative colitis: a systematic review. Dis Colon Rectum 65(S1):S5–S19. (PMID: 360071659907776)
Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V et al (2022) ECCO guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 16(2):179–189. (PMID: 10.1093/ecco-jcc/jjab17734635910)
Lightner AL, Mathis KL, Dozois EJ, Hahnsloser D, Loftus EV Jr., Raffals LE et al (2017) Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis 23(5):781–790. (PMID: 10.1097/MIB.000000000000106128301429)
Singh P, Bhangu A, Nicholls RJ, Tekkis P (2013) A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy. Colorectal Dis 15(7):e340–e351. (PMID: 10.1111/codi.1223123560590)
Violante T, Ferrari D, Gomaa IA, Rumer KK, D’Angelo AD, Behm KT et al (2024) Evolution of laparoscopic ileal pouch-anal anastomosis: impact of enhanced recovery program, medication changes, and staged approaches on outcomes. J Gastrointest Surg 28(4):501–506. (PMID: 10.1016/j.gassur.2024.01.00538583902)
Khawaja Z, Jamal Z, Zafar N, Adnan N, Haider MI, Zafar A et al (2023) Role of robotic approach in ileal pouch-anal anastomosis (IPAA): a systematic review of the literature. J Robot Surg 17(3):941–947. (PMID: 10.1007/s11701-022-01490-x36380262)
Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y (2013) A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 258(2):275–282. (PMID: 10.1097/SLA.0b013e318281374123360923)
Gorgun E, Remzi FH (2004) Complications of ileoanal pouches. Clin Colon Rectal Surg 17(1):43–55. (PMID: 10.1055/s-2004-823070200112842780072)
Ng KS, Gonsalves SJ, Sagar PM (2019) Ileal-anal pouches: a review of its history, indications, and complications. World J Gastroenterol 25(31):4320–4342. (PMID: 10.3748/wjg.v25.i31.4320314966166710180)
Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J et al (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238(4):605–614. (PMID: 10.1097/01.sla.0000090940.39838.6a145307321360119)
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. (PMID: 10.1136/bmj.n71337820578005924)
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. (PMID: 10.1136/bmj.i4919277333545062054)
Hartley JE, Fazio VW, Remzi FH, Lavery IC, Church JM, Strong SA et al (2004) Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 47(11):1808–1815. (PMID: 10.1007/s10350-004-0644-615622572)
Korsgen S, Keighley MR (1997) Causes of failure and life expectancy of the ileoanal pouch. Int J Colorectal Dis 12(1):4–8. (PMID: 10.1007/s0038400500699112142)
Pace DE, Seshadri PA, Chiasson PM, Poulin EC, Schlachta CM, Mamazza J (2002) Early experience with laparoscopic ileal pouch-anal anastomosis for ulcerative colitis. Surg Laparosc Endosc Percutan Tech 12(5):337–341. (PMID: 10.1097/00129689-200210000-0000612409700)
Lim MH, Lord AR, Simms LA, Hanigan K, Edmundson A, Rickard M et al (2021) Ileal pouch-anal anastomosis for ulcerative colitis: an australian institution’s experience. Ann Coloproctol 37(5):318–325. (PMID: 10.3393/ac.2020.08.2632972106)
Yu CS, Pemberton JH, Larson D (2000) Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 43(11):1487–1496. (PMID: 10.1007/BF0223672611089581)
Grotz RL, Pemberton JH (1993) The ileal pouch operation for ulcerative colitis. Surg Clin North Am 73(5):909–932. (PMID: 10.1016/S0039-6109(16)46133-58378832)
Davies M, Hawley PR (2007) Ten years experience of one-stage restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 22(10):1255–1260. (PMID: 10.1007/s00384-006-0243-117216220)
Salemans JM, Nagengast FM, Lubbers EJ, Kuijpers JH (1992) Postoperative and long-term results of ileal pouch-anal anastomosis for ulcerative colitis and familial polyposis coli. Dig Dis Sci 37(12):1882–1889. (PMID: 10.1007/BF013080831335407)
Germain A et al (2018) Outcome of restorative proctocolectomy with an ileo-anal pouch for ulcerative colitis: effect of changes in clinical practice. Colorectal Dis 20(2):O30–O38. (PMID: 10.1111/codi.1394829091335)
Hassan I, Horgan AF, Nivatvongs S, Harrington J, Larson DR (2003) Outcome of patients undergoing ileal pouch-anal anastomosis for left-sided chronic ulcerative colitis. J Gastrointest Surg 7(4):567–571. (PMID: 10.1016/S1091-255X(02)00137-312763418)
Johnson E, Carlsen E, Nazir M, Nygaard K (2001) Morbidity and functional outcome after restorative proctocolectomy for ulcerative colitis. Eur J Surg 167(1):40–45. (PMID: 11213820)
Mikkola K, Luukkonen P, Jarvinen HJ (1995) Long-term results of restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 10(1):10–14. (PMID: 10.1007/BF003375787745315)
Colombo PL, Tinozzi FP, Abelli M, Pini G, Benedetti M, Moglia P et al (2002) Clinical and functional results after restorative proctocolectomy with ileal J reservoir in the treatment of ulcerative colitis. Ann Ital Chir 73(3):287–296. (PMID: 12404896)
Linden BC, Bairdain S, Zurakowski D, Shamberger RC, Lillehei CW (2013) Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents. J Pediatr Surg 48(7):1546–1550. (PMID: 10.1016/j.jpedsurg.2012.08.03123895970)
Zittan E, Ma GW, Wong-Chong N, Milgrom R, McLeod RS, Silverberg M et al (2017) Ileal pouch-anal anastomosis for ulcerative colitis: a Canadian institution’s experience. Int J Colorectal Dis 32(2):281–285. (PMID: 10.1007/s00384-016-2670-y27704203)
Ouaissi M, Lefevre JH, Bretagnol F, Alves A, Valleur P, Panis Y (2008) Laparoscopic 3-step restorative proctocolectomy: comparative study with open approach in 45 patients. Surg Laparosc Endosc Percutan Tech 18(4):357–362. (PMID: 10.1097/SLE.0b013e3181772d7518716534)
Lillehei CW, Leichtner A, Bousvaros A, Shamberger RC (2009) Restorative proctocolectomy and ileal pouch-anal anastomosis in children. Dis Colon Rectum 52(9):1645–1649. (PMID: 10.1007/DCR.0b013e3181a8fd5f19690495)
Canedo JA, Pinto RA, McLemore EC, Rosen L, Wexner SD (2010) Restorative proctectomy with ileal pouch-anal anastomosis in obese patients. Dis Colon Rectum 53(7):1030–1034. (PMID: 10.1007/DCR.0b013e3181db702920551755)
Hassab T, McKinney D, D’Adamo CD, Svoboda S, Katlic M, Wolf JH (2022) Short-term outcomes for restorative and non-restorative proctocolectomy in older adults. J Surg Res 269:11–17. (PMID: 10.1016/j.jss.2021.07.01234500178)
Giudici F, Scaringi S, Di Martino C, Ficari F, Bechi P (2017) Rationalisation of the surgical technique for minimally invasive laparoscopic ileal pouch-anal anastomosis after previous total colectomy for ulcerative colitis. J Minim Access Surg 13(3):188–191. (PMID: 10.4103/0972-9941.199607286072855485807)
Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V et al (2022) ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. J Crohns Colitis 16(1):2–17. (PMID: 10.1093/ecco-jcc/jjab17834635919)
Gordon H, Minozzi S, Kopylov U, Verstockt B, Chaparro M, Buskens C et al (2024) ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis 18(10):1531–1555. (PMID: 10.1093/ecco-jcc/jjae09138877997)
Pugliese D, Felice C, Papa A, Gasbarrini A, Rapaccini GL, Guidi L et al (2017) Anti TNF-alpha therapy for ulcerative colitis: current status and prospects for the future. Expert Rev Clin Immunol 13(3):223–233. (PMID: 10.1080/1744666X.2017.124346827687496)
Rocha R, de Jsg G, Santana G (2021) Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease. World J Gastrointest Pharmacol Ther 12(5):90–99. (PMID: 10.4292/wjgpt.v12.i5.90346165858465395)
Law CCY, Koh D, Bao Y, Jairath V, Narula N (2020) Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 26(12):1796–1807. (PMID: 10.1093/ibd/izaa02032047894)
Pooni A, Brar MS, Kennedy E, Cohen Z, MacRae H, de Buck Overstraetenvan A (2024) Routine diversion following delayed IPAA construction does not reduce the incidence of pouch-related sepsis or failure in patients with ulcerative colitis. Colorectal Dis 26(2):326–334. (PMID: 10.1111/codi.1683638169082)
Flynn J, Larach JT, Kong JCH, Warrier SK, Heriot A (2021) Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis. Int J Colorectal Dis 36(7):1345–1356. (PMID: 10.1007/s00384-021-03868-z33611619)
Abdelaal A, Ari K, Rafaih AB, Memon AA, Shaikh I, Iqbal MR (2025) Comparing surgical outcomes of robotic and laparoscopic or open ileal pouch-anal anastomosis: a systematic review and meta-analysis. J Robot Surg 19(1):544. (PMID: 10.1007/s11701-025-02707-540889021)
Uchino M, Ikeuchi H, Horio Y, Kuwahara R, Kusunoki K, Nagano K et al (2024) The impacts of laparoscopic restorative proctocolectomy for ulcerative colitis: systematic review and meta-analysis. Inflam Intest Dis 9(1):62–70. (PMID: 10.1159/000535832)
Alipouriani A, Hull T, Lipman J, Holubar SD, Gorgun E, Liska D et al (2024) Diagnosis and treatment of primary ileal pouch leaks: a 27-year experience at a referral center. J Gastrointest Surg 28(6):860–866. (PMID: 10.1016/j.gassur.2024.03.01538553296)
Pellino G, Celentano V, Vinci D, Romano FM, Pedone A, Vigorita V et al (2023) Ileoanal pouch-related fistulae: a systematic review with meta-analysis on incidence, treatment options and outcomes. Dig Liver Dis 55(3):342–349. (PMID: 10.1016/j.dld.2022.05.00935688686)
Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC et al (2013) Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 7(7):556–585. (PMID: 10.1016/j.crohns.2013.02.02023583097)
Panel AIEC, Shen B, Abreu MT, Cohen ER, Farraye FA, Fischer M, ASGE IBD Endoscopy Consensus Panel et al (2025) Endoscopic diagnosis and management of adult inflammatory bowel disease: a consensus document from the American Society for Gastrointestinal Endoscopy IBD Endoscopy Consensus Panel. Gastrointest Endosc 101(2):295–314. (PMID: 10.1016/j.gie.2024.08.034)
Vespa E, D’Amico F, Sollai M, Allocca M, Furfaro F, Zilli A et al (2022) Histological scores in patients with inflammatory bowel diseases: the state of the art. J Clin Med 11(4):939. (PMID: 10.3390/jcm11040939352072118880199)
Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V et al (2019) ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 13(2):144–164. (PMID: 10.1093/ecco-jcc/jjy11330137275)
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. (PMID: 10.1097/01.sla.0000133083.54934.ae152735421360123)
Contributed Indexing: Investigator: V De Simone; F Palmieri; G Gravante
Keywords: Ileal J pouch; Ileal pouch-anal anastomosis (IPAA); Ileoanal anastomosis; J-pouch; Pouch
Entry Date(s): Date Created: 20260216 Date Completed: 20260729 Latest Revision: 20260729
Update Code: 20260729
DOI: 10.1007/s13304-026-02529-6
PMID: 41697605
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:2038-3312
DOI:10.1007/s13304-026-02529-6