Introduction: Ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in selected patients affected by inflammatory bowel disease (IBD). Since its inception in 1978, IPAA has undergone significant improvements mainly secondary to the changing in of surgical approaches. We elaborated a systematic review reporting surgical outcomes after IPAA for IBD over three decades, from the open to the transanal approach.
Methods: A systematic review of published articles according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement 2020 was conducted. An extensive electronic literature search was carried out in MEDLINE (via PubMed), EMBASE and Web of Science, using key words such as “ileal J pouch anal anastomosis”, ”J-pouch”, and “IPAA”. Case reports, systematic reviews, meta-analyses, letter to the editor, and studies involving animals were excluded. Patients were divided into three groups based on the study periods (A: 1980-1999; B: 2000-2009; C: 2010-2023).
Results: Twenty-six articles including 6381 patients who underwent IPAA for IBD [6214 ulcerative colitis (97.4%), 77 Crohn’s disease (1.2%), 90 indeterminate colitis (1.4%)] were included. In group A, B and C 4444 (69.6%), 1398 (21.9%) and 539 (8.4) patients were included, respectively. Of these, 1703 (38.3%), 611 (43.7%) and 380 (70.5%) were women, respectively. Median age was 34, 29 and 34 years for group A, B and C, respectively. Laparoscopic approach was used in 500 (11.3%), 378 (27%) and 460 (85.3%) patients, respectively. Median length of hospital stay (LOS) was, in case of open or minimally invasive approach, 12 and 7 days, 8 and 13 days, and 9 and 6 days for group A, B and C, respectively. Two-stage approach was used for 323 (7.2%), 572 (40.9%) and 139 (25.7%) patients in group A, B and C, respectively. Overall, postoperative surgical complications were 1818 (40.9%), 447 (32%) and 117 (21.7%) in group A, B and C, respectively. The most common complications were small bowel obstruction (766, 12%), anastomotic leak (521, 8.2%), anal stricture (493, 7.7%), fistula (292, 4.6%), and bleeding (40, 0.6%).
Conclusions: The present systematic review reports as IPAA for IBD in the last decade has been performed mainly by minimally invasive approach, obtaining better short and long term postoperative results. In the next decade the transanal approach may further improve the postoperative outcomes.

Francesco Virgilio

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