Does laparoscopic ileal pouch-anal anastomosis reduce infertility compared with open approach?

Abstract

BACKGROUND:

The aim of this study was to assess the association of the mode of surgery on female fertility after restorative proctocolectomy with ileal pouch-anal anastomosis.

METHODS:

All female patients aged 18 to 44 years who underwent restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis, familial adenomatous polyposis, or Crohn's disease at the Cleveland Clinic Ohio or the Cleveland Clinic Florida from 1983 to 2012 were sent a standardized fertility questionnaire. Infertility was defined as lack of pregnancy after 1 year of unprotected sexual intercourse. Patients who had attempted to conceive after restorative proctocolectomy with ileal pouch-anal anastomosis were compared based on the surgical approach: laparoscopic ileal pouch-anal anastomosis versus open ileal pouch-anal anastomosis.

RESULTS:

A total of 890 female patients were surveyed, of which 519 (58.3%) responded. Of these, 161 (31%) had attempted pregnancy after surgery: 18 (12%) had laparoscopic ileal pouch-anal anastomosis and 143 (88%) had open ileal pouch-anal anastomosis. There were no significant differences regarding demographics between groups. There was no difference in reported infertility rates (61.1% vs 65%, respectively, P = 0.69) between the laparoscopic ileal pouch-anal anastomosis and open ileal pouch-anal anastomosis groups. The median time to pregnancy (3.5 months vs 9 months, respectively, log-rank P = 0.01) was reduced in patients who underwent laparoscopic ileal pouch-anal anastomosis compared with those who underwent open ileal pouch-anal anastomosis.

CONCLUSION:

Postoperative infertility rates were higher after ileal pouch-anal anastomosis regardless of mode of surgery. However, laparoscopy was associated with a significantly reduced time to conceive compared with the open approach.

• Authors: Emre Gorgun, Turgut Bora Cengiz, Erman Aytac, Alexandra Aiello, Giovanna da Silva, Jeffrey M Goldberg, Stefan D Holubar, Luca Stocchi, Steven D Wexner, Scott R Steele, Tracy L Hull
• Journal: Surgery (Surgery) Vol. 166 Issue 4 Pg. 670-677 (10 2019) ISSN: 1532-7361 [Electronic] United States
• PMID: 31420214 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Academic Medical Centers
• Adolescent
• Adult
• Cohort Studies
• Colectomy (methods)
• Colitis, Ulcerative (pathology, surgery)
• Crohn Disease (pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Infertility, Female (epidemiology, etiology)
• Inflammatory Bowel Diseases (pathology, surgery)
• Laparoscopy (adverse effects, methods)
• Laparotomy (adverse effects, methods)
• Proctocolectomy, Restorative (adverse effects, methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Surveys and Questionnaires
• Young Adult