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<p>Ileal pouch–anal anastomosis (IPAA) has been the preferred surgical treatment for selected patients with inflammatory bowel disease (IBD) since its introduction in 1978. Over the past 3 decades, significant advances have occurred, particularly with the evolution of minimally invasive surgical techniques. This systematic review aimed to analyze surgical outcomes following IPAA over the last 30&#xa0;years, focusing on the transition from open to minimally invasive approaches. A comprehensive search was conducted in PubMed, Embase, and Web of Science, yielding 46,024 articles. Studies were categorized into three time periods: Group A (1980–1999), Group B (2000–2009), and Group C (2010–2025). The review was registered in PROSPERO (CRD42024604869). Twenty studies published between 1981 and 2018 were included, encompassing a total of 5474 patients. Group A comprised 3903 patients (71.3%), Group B 1312 (24.0%), and Group C 259 (4.7%). Use of laparoscopic approaches increased substantially over time: 11.9% in Group A, 26.2% in Group B, and 54.4% in Group C. Conversely, the rate of diverting loop ileostomy decreased from 88.6% in Group A to 69.9% in Group B and 23.8% in Group C. The proportion of patients undergoing concomitant proctocolectomy at the time of IPAA declined markedly from 93.1% (Group A) to 38.4% (Group B) and 22% (Group C). Length of hospital stay progressively decreased, with mean durations of 11.9 ± 2.6&#xa0;days, 11.0 ± 5.4&#xa0;days, and 7.8 ± 2.7&#xa0;days in Groups A, B, and C, respectively. Postoperative complication rates also declined significantly: 86.7% in Group A, 66.8% in Group B, and 37.8% in Group C. Over the last three decades, surgical outcomes following IPAA for IBD have markedly improved. This improvement coincides with an increased use of minimally invasive techniques and a shift toward staged surgical approaches.</p>

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A systematic review on surgical trends after ileal pouch-anal anastomosis for inflammatory bowel disease: shifting the focus from traditional to minimally invasive approaches

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Gaetano Gallo,
  • Stefano Agnesi,
  • Silvio Danese,
  • Andrea Vignali,
  • Veronica De Simone,
  • Francesco Palmieri,
  • Gianpiero Gravante,
  • Pierpaolo Sileri

摘要

Ileal pouch–anal anastomosis (IPAA) has been the preferred surgical treatment for selected patients with inflammatory bowel disease (IBD) since its introduction in 1978. Over the past 3 decades, significant advances have occurred, particularly with the evolution of minimally invasive surgical techniques. This systematic review aimed to analyze surgical outcomes following IPAA over the last 30 years, focusing on the transition from open to minimally invasive approaches. A comprehensive search was conducted in PubMed, Embase, and Web of Science, yielding 46,024 articles. Studies were categorized into three time periods: Group A (1980–1999), Group B (2000–2009), and Group C (2010–2025). The review was registered in PROSPERO (CRD42024604869). Twenty studies published between 1981 and 2018 were included, encompassing a total of 5474 patients. Group A comprised 3903 patients (71.3%), Group B 1312 (24.0%), and Group C 259 (4.7%). Use of laparoscopic approaches increased substantially over time: 11.9% in Group A, 26.2% in Group B, and 54.4% in Group C. Conversely, the rate of diverting loop ileostomy decreased from 88.6% in Group A to 69.9% in Group B and 23.8% in Group C. The proportion of patients undergoing concomitant proctocolectomy at the time of IPAA declined markedly from 93.1% (Group A) to 38.4% (Group B) and 22% (Group C). Length of hospital stay progressively decreased, with mean durations of 11.9 ± 2.6 days, 11.0 ± 5.4 days, and 7.8 ± 2.7 days in Groups A, B, and C, respectively. Postoperative complication rates also declined significantly: 86.7% in Group A, 66.8% in Group B, and 37.8% in Group C. Over the last three decades, surgical outcomes following IPAA for IBD have markedly improved. This improvement coincides with an increased use of minimally invasive techniques and a shift toward staged surgical approaches.