Minimally invasive surgical may protect postoperative bowel dysfunction after restorative proctectomy

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a surgical procedure performed when excising the entire colon and rectum is need and reconstitution of the intestinal transit through an ileal pouch is made with anastomosis to the anus.

The purpose of this study was to describe postoperative bowel dysfunction after restorative proctectomy, and to identify factors associated with its development.

Patients who underwent restorative proctectomy for rectal cancer between April 1998 and November 2018 were identified from the Hospital Episode Statistics database and linked to the Clinical Practice Research Datalink for postoperative follow-up. Bowel dysfunction was defined according to relevant symptom-based read codes and medication prescription–product codes. A Cox proportional hazards model was performed to identify factors associated with postoperative bowel dysfunction, adjusting for relevant covariates.

Results:

• In total, 2,197 patients were included. The median age was 70.0 years old, and the majority (59.2%) of patients were male.
• After a median follow-up of 51.6 (24.0–90.0) months, bowel dysfunction was identified in 620 (28.2%) patients. Risk factors for postoperative bowel dysfunction included extremes of age, radiotherapy distal tumors, history of diverting ostomy, and anastomotic leak
• A minimally invasive surgical approach was protective for postoperative bowel dysfunction

Thus, bowel dysfunction was common after restorative proctectomy, and several patient, disease, and treatment-level factors were associated with its development. However  minimally invasive surgical approach was protective for postoperative bowel dysfunction.

Reference:

Richard Garfinkle, Sophie Dell'Aniello, Sahir Bhatnagar, Nancy Morin, Gabriela Ghitulescu, Julio Faria, Carol-Ann Vasilevsky, Paul Brassard, Marylise Boutros. Assessment of long-term bowel dysfunction after restorative proctectomy for neoplastic disease: A population-based cohort study, Surgery, Volume 172, Issue 3, 2022, Pages 782-788, ISSN 0039-6060, https://doi.org/10.1016/j.surg.2021.10.068.