Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients

Background. The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA) Methods. Patients undergoing a primary IPAA (1983-2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional outcomes, and quality of life (QOL) were investigated. Results. Of 3,382 patients with a primary IPAA, 3,109 were included. Median follow-up was 7.1 years (0.1-24). Mean age was 37.9 +/- 13.2 years. Overall, 1,741 patients (56%) were male. Group A (n = 474) and group B (n = 2635) had similar age (P = 28), sex (P = 8), albumin level (P = .74), prior colectomy (P = .98), and use of steroids (P < 001). Group A had a greater use of ileostomy (P = .001) and a longer duration of stay (P < 001). Group B had a greater body mass index (P < 001) and J-puch (P <= .001) Wound infection (P = .42) and pouchius (P = .59) were similar Anastomotic structure (P = .002), septic complications (P = .019), bowel obstruction (P = .027), and pouch failure (P < 001) were greater in group A. At most recent follow-up, bowel frequence (P = .74) and rate of urgency were similar (P = 71). A greater proportion of patients in group A described incontinence (P < .001), seepage (P < .001), pad usage (P < .001), dietary (P < .001), social (P < .001), and work restrictions (P = 025). The cleveland Global QOL score (P = .018) was greater in group B. Conclusion. Patients undergoing a stapled IPAA had better outcomes and QOL than those undergoing a hand-sewn IPAA (Surgery 2009, 146:723-30.)