Risk Factors for Prolonged Operative Time in Hand-Sewn Laparoscopic IPAA for Ulcerative Colitis.

INTRODUCTION

Laparoscopic-assisted total proctocolectomy and ileal pouch-anal anastomosis (Lap-IPAA) is a standard surgical procedure for patients with ulcerative colitis (UC), but its operative time can be prolonged due to technical complexity and disease-specific factors. This study aimed to identify risk factors associated with prolonged operative time in hand-sewn Lap-IPAA.

METHODS

This retrospective single-center study included 156 patients with UC who underwent hand-sewn Lap-IPAA between January 2018 and June 2024. Patients receiving stapled IPAA or open surgery were excluded. Clinical, laboratory, surgical, and perioperative data were collected from electronic records. Prolonged operative time was defined as ≥ 370 min (75th percentile). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

RESULTS

Among the 156 patients, 40 (25.6%) were classified into the prolonged operative time group. Male sex (80.0% vs. 51.7%, p = 0.002) and higher BMI (21.7 vs. 18.6 kg/m2, p < 0.001) were significantly more common in the prolonged group. Multivariate analysis confirmed male sex (OR, 5.153; 95% CI, 1.927-13.779; p < 0.001) and BMI (OR, 1.323; 95% CI, 1.146-1.526; p < 0.001) as independent risk factors. Other variables, including UC severity, albumin, CRP, and preoperative immunosuppressive therapies, were not significantly associated with operative time.

CONCLUSION

Male sex and elevated BMI were independently associated with prolonged operative time in hand-sewn Lap-IPAA for UC. These findings highlight the importance of preoperative planning and support the centralization of complex UC surgeries to experienced centers, particularly for high-risk patients.