Robotic versus laparoscopic versus open ileoanal pouches in a busy District General Hospital setting

Purpose: Ileo-anal pouch anastomosis (IPAA) is an optimal procedure for patients with chronic ulcerative colitis and familial adenomatous polyposis (FAP), for whom restoration of continuity is a priority. Due concerns of long term outcomes, there have been discussions about centralisation of this procedure. We report the evolution of the service at our trust. The aim of this study was to present our series of consecutive patients who underwent IPAA (open, laparoscopic and robotic) with respect to the surgical and functional outcomes. Methods: Data were prospectively collected from consecutive IPAA cases from January, 2014 to March, 2023. Patient demographics, operative details, postoperative complications, functional outcomes were collected. Patients were selected by IBD specialized surgeons and reviewed by a pouch nurse. Follow-up consisted of clinical examination and assessment of pouch function. Results: Thirty-six patients underwent IPAA over the study period. 18 underwent laparoscopic surgery, of these, two were converted to open. 6 underwent robotic, one was converted to open, making 15 open cases. The median operative time was 395minutes. Major complications (Clavien-Dindo III-IV) were seen in three patients (8.34%). Median post operative length of stay was 8 days. The 30-day re-admission rate was 30.56%, the most common cause being high stoma output. There were no mortalities. The median Oresland Score was 6, and SIBDQ score was 51. Conclusion: Our data suggests that with good patient selection and guidance from an experienced team, is safe and feasible with good peri-operative outcomes and acceptable pouch function in a District General Hospital setting.