Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis

S. A.L. Bartels, T. J. Gardenbroek, M. Aarts, C. Y. Ponsioen, P. J. Tanis, C. J. Buskens, W. A. Bemelman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

57 Citations (Scopus)
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Abstract

Background: 

Posterior rectal dissection during ileal pouch-anal anastomosis (IPAA) can be performed in the total mesorectal excision (TME) or close rectal dissection (CRD) plane. The aim of this study was to compare morbidity and quality of life (QoL) in patients having TME or CRD during proctectomy followed by IPAA for benign disease. 

Methods:

In this randomized clinical trial, patients undergoing IPAA were allocated to TME or CRD. Thirty-day morbidity was determined and QoL assessed using Short Form 36, GIQLI (GastroIntestinal Quality of Life Index) and COREFO (COloREctal Functional Outcome) questionnaires. The primary outcome (pouch compliance) of the trial is to be reported separately. 

Results: 

Fifty-nine patients were included, 28 in the CRD and 31 in the TME group. Baseline data were similar, except for more previous abdominal surgery in the TME group. Operating time was longer for patients having CRD (195min versus 166min for TME; P=0·008). More patients in the TME group had a primary defunctioning ileostomy (7 of 31 versus 1 of 28 for CRD; P=0·055). Severe complications occurred more frequently in the TME group (10 of 31 versus 2 of 28 for CRD). QoL was better in the CRD group for several subscales of the questionnaires measured at 1, 3 and 6 months after surgery. At 12 months, QoL was similar in the two groups for all subscales. 

Conclusion: 

CRD led to a lower severe complication rate and better short-term QoL than wide TME.

Original languageEnglish
Pages (from-to)281-287 and e189
JournalBritish Journal of Surgery
Volume102
Issue number3
DOIs
Publication statusPublished - Feb 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2014 BJS Society Ltd. Published by John Wiley & Sons, Ltd.

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