The following is a summary of “Laparoscopic Versus Transanal IPAA for Ulcerative Colitis: A Patient-Centered Treatment Trade-Off Study,” published in the January 2024 issue of Gastroenterology by Yang, et al.
Transanal IPAA is a fairly new method that aims to make surgery less invasive while also making it easier to reach the pelvis in people who have ulcerative colitis. At this point, patients’ choices about surgery have never been looked into.
For a study, researchers sought out which patients would prefer between transanal and laparoscopic IPAA by determining how much risk they are willing to take for transanal surgery, as measured by pouch function loss. They used the threshold method to do normal conversations with patients.
Standardized interviews using the threshold method were done with people who had ulcerative colitis, whether they had had pouch surgery before or not. They found out how much more frequent bowel movements, urgent bowel movements, and fecal incontinence patients would be willing to have if they had transanal IPAA. Thirty-two patients (mean age: 38.7 years±15.3 years) who had surgery before and twenty patients (mean age: 39.5 years±11.9 years) who had never had surgery before took part in this study.
For transanal IPAA to work, patients agreed to have two more bowel movements a day and one episode of fecal leakage a month. Also, they agreed to 10 minutes of worsening bowel pressure (i.e., 10 minutes less “holding time”) for transanal surgery (ie, decrease of 10 minutes in “holding time”). Younger patients (ages 21 to 29) would only agree to a 5-minute reduction in “holding time” (P = 0.02). Patients were ready to risk having less pouch function in exchange for the less invasive transanal IPAA method. To help people make smart choices about surgery, more research needs to be done on the long-term functional results of transanal IPAA.