S35 Transanal Ileal Pouch-anal Anastomosis for Inflammatory Bowel Disease (ta-IPAA): A Systematic Review and Meta-analysis
Notice bibliographique
Résumé
Background: Restorative proctocolectomy with transabdominal ileal pouch-anal anastomosis (abd-IPAA) has become the standard surgical treatment for medically-refractory ulcerative colitis (UC). However, this approach requires a technically difficult distal rectal dissection and anastomosis due to the bony confines of the deep pelvis. To address these challenges, the transanal IPAA approach (ta-IPAA) was developed. This novel approach may offer increased visibility and range of motion compared to abd-IPAA, although its postoperative benefits remain unclear. We performed a systematic review and meta-analysis to compare postoperative outcomes between ta-IPAA and abd-IPAA for patients with UC and to inform the frequency of postoperative outcomes in patients who underwent ta-IPAA. Methods: Ovid MEDLINE(R), EMBASE, Cochrane and Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until May 2022 for comparative and non-comparative studies reporting postoperative outcomes of patients undergoing ta-IPAA. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. Odds ratios (OR), mean differences (MD), and prevalence ratio (PR) and their corresponding 95% confidence intervals (CI) were calculated using random-effects models. Sensitivity analysis was performed. Risk of bias was assessed based on the 9-star Newcastle Ottawa Scale for cohort-studies and for case series with a modified tool proposed by Murad et. al. Results: Ten studies comprising 283 patients with ta-IPAA were included. The cuff length was 1 to 2 cm from the transition zone in almost all studies. Total mesorectal excision was performed in 61.8% of cases and close rectal dissection in 27.9%. There was no difference in the odds of Clavien-Dindo I-II complications (OR: 0.96, 95%CI 0.27, 3.40; I2: 83%; n = 137) between ta-IPAA and abd-IPAA. The ta-IPAA pooled Clavien-Diendo I-II complications rate was 18% (95%CI 5%, 35%; I2: 83%; n = 83). ta-IPAA had no difference in the risk of Clavien Dindo III-IV complications (OR: 1.18, 95%CI 0.65, 2.16; I2: 0%; n = 57) when compared to abd-IPAA. The ta-IPAA pooled Clavien-Diendo III-IV complications rate was 10% for ta-IPAA (95%CI 5%, 17%; I2: 41%; n = 42). There was no difference in the risk of anastomotic leak between ta-IPAA and abd-IPAA (OR: 1.37, 95%CI 0.58, 3.23; I2: 0%). The pooled anastomotic leak rate was 6% for ta-IPAA (95%CI 2%, 10%; I2: 0%; n = 15). There were no deaths reported for ta-IPAA. There was no difference in mean operative time (MD: -5.34, 95%CI -24.01, 13.32; I2 = 49%; n = 329) or mean length of hospital stay (MD: −0.45, 95%CI −2.93, 2.03; I2 = 95%; n = 329) between ta-IPAA and abd-IPAA. Overall, the risk of bias was low in 3 studies, moderate in 4 studies, and high in 3 studies. Conclusion(s): This meta-analysis compared the novel ta-IPAA to the traditional abd-IPAA and found no difference in postoperative complications. Though, the frequency of postoperative complications was high in ta-IPAA. While the need for randomized controlled trails and comparison of functional outcomes between both approaches remains, this evidence should assist colorectal surgeons in deciding if the ta-IPAA is a viable alternative.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,021 | 0,038 |
| Bibliométrie | 0,010 | 0,010 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».