The impact of colectomy and restorative procedure on pouch function after ileo-pouch-anal anastomosis in ulcerative colitis. The icon fun study on behalf of the Italian Society of Colon and Rectal Surgery (SICCR) Inflammatory Bowel Diseases committee

background: available guidelines lack in indications on surgical standard in ulcerative colitis (UC) aims: to determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. the secondary aims consisted of perioperative outcomes and complications. methods: data on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological low-anterior-resection-syndrome (LARS) score. results: mesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). the transanal-transection and single-stapling anastomosis (TTSS) showed to be protective against pouchitis. extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057). conclusions: the study highlights advantages of laparoscopy. new techniques such as TTSS promise further improvements. mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.