Bowel function and quality of life after robotic and laparoscopic IPAA: a patient-reported outcomes study.

BACKGROUND

Minimally invasive ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis or familial adenomatous polyposis, offering numerous benefits over open surgery. However, the impact of robotic surgery on long-term quality of life (QoL) remains poorly defined.

OBJECTIVE

To analyze QoL after robotic and laparoscopic IPAA using a validated patient-reported outcome instrument.

DESIGN

This retrospective, STROBE-compliant study analyzed 158 patients who underwent laparoscopic (n = 112) or robotic (n = 46) IPAA at a single, tertiary-care institution.

SETTINGS: Data were collected at a single, tertiary-care institution.

PATIENTS: The study included 158 patients who underwent laparoscopic (n = 112) or robotic (n = 46) IPAA. All patients had a J-pouch procedure and had at least 12 months of restored intestinal continuity.

INTERVENTIONS: Laparoscopic or robotic IPAA.

MAIN OUTCOME MEASURES: QoL was assessed using a modified, validated Ileoanal Pouch Syndrome Severity Score (IPSS) survey at least 12 months after ileostomy closure.

RESULTS

Both groups experienced similar overall QoL, with a high prevalence of severe or extremely severe pouch-related symptoms (55.1%). Robotic IPAA was associated with longer operative times but less blood loss. Worse IPSS scores correlated with hand-sewn IPAA with mucosectomy and postoperative septic complications. Despite these challenges, 92% of patients preferred IPAA over ileostomy.

LIMITATIONS: Retrospective design and potential for non-response bias. The modified IPSS survey may not fully capture all aspects of QoL.

CONCLUSIONS

In this cohort, robotic and laparoscopic IPAA resulted in comparable QoL as measured by a validated patient-reported outcome instrument. Significant pouch dysfunction remains prevalent regardless of surgical approach. Modifiable factors, such as hand-sewn anastomosis and septic complications, negatively impact patient-reported outcomes.