Increasing experience of modified two‐stage transanal ileal pouch–anal anastomosis for therapy refractory ulcerative colitis. What have we learned? A retrospective analysis on 75 consecutive cases at a tertiary referral hospital

Abstract Aim Ileal pouch–anal anastomosis (IPAA) should be delayed to a second stage in patients with ulcerative colitis and prolonged exposure to medical therapy. However, there is still discussion about whether a modified two‐stage approach is preferable to a three‐stage approach. Recently, a transanal approach has been introduced to overcome the well‐known difficulties of laparoscopic pelvic surgery. This paper presents short‐term outcomes of transanal IPAA (Ta‐IPAA) according to a modified two‐stage approach. Methods Data from all patients who underwent a modified two‐stage Ta‐IPAA for ulcerative colitis refractory to medical therapy were retrieved retrospectively from a prospective database. A comprehensive complication index was used for 90‐day postoperative complications. Conversion, duration of surgery, hospital stay and reoperation were considered. A logistic regression model was used to assess risk factors for peri‐pouch sepsis. Results Seventy‐five (68.8%) patients were identified from 109 consecutive IPAAs. Median operation time was 159 min. Conversion rate was 4%. Mean comprehensive complication index was 7. All anastomotic leaks (10.6%) were treated with diverting ileostomy. Additionally, active rescue with transanal drainage and early resuturing of the anastomotic gap was performed in six patients. Ileostomy closure occurred after a median period of 5.4 months. At univariable analysis, factors associated with peri‐pouch sepsis were male gender and age at IPAA construction. Conclusions A modified two‐stage Ta‐IPAA is safe and feasible. Standardization and reproducibility of the technique are reflected in few conversions and intra‐operative complications. Finally, morbidity and anastomotic leak do not differ from those reported in previous Ta‐IPAA series with a variable proportion of multistage procedures.