Current status of fertility rates and modes of delivery after restorative proctocolectomy with ileal pouch-anal anastomosis.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2025-06-20 DOI:10.1007/s00384-025-04938-2

Hideaki Kimura, Kenichiro Toritani, Reiko Kunisaki, Koki Goto, Hirosuke Kuroki, Kenji Tatsumi, Kazutaka Koganei, Akira Sugita, Itaru Endo

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引用次数: 0

Abstract

Purpose: After restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA), fertility rates decline, and cesarean section (CS) has been the preferred mode of delivery. We aimed to assess the current trends and outcomes of pregnancy and delivery in patients who underwent RPC with IPAA.

Methods: This retrospective cohort study included 386 patients who underwent RPC with IPAA for UC between 2007 and 2023. Clinical data were collected through a chart review. Surgical techniques were mainly one- or modified two-stage RPC with stapled IPAA. The fallopian tube traction technique was applied to prevent adhesions. Fertility rates and delivery outcomes were also examined.

Results: Among 83 females of < 40 years of age, 18 attempted pregnancy after surgery. Natural conception was achieved in 14 cases (78%), and 2 cases were conceived through in vitro fertilization, resulting in a total of 16 pregnancies (89%). Among the 15 births, 11 (73%) were vaginal deliveries (VD), and 4 (27%) were CS. The reasons for CS included breech presentation (2 cases), prior CS (1 case), and a history of rectovaginal fistula (1 case). One VD case required episiotomy and the other experienced a perineal tear. However, there were no significant differences in postpartum defecation between the VD and CS groups.

Conclusion: Fertility after RPC with IPAA appears to have improved compared to previous reports, possibly due to the prevention of fallopian tube adhesions. After a stapled IPAA, VD is a feasible option, and CS is not universally required solely because of the history of IPAA.

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回肠袋-肛管吻合术恢复性直结肠切除术后生育率及分娩方式的现状。

目的：恢复性直结肠切除术（RPC）联合回肠袋-肛门吻合术（IPAA）后，生育率下降，剖宫产（CS）一直是首选的分娩方式。我们的目的是评估RPC合并IPAA患者妊娠和分娩的当前趋势和结果。方法：这项回顾性队列研究纳入了2007年至2023年间386例UC患者接受了RPC联合IPAA治疗。临床资料通过图表回顾收集。手术技术主要是一期或改良的两期RPC与钉接IPAA。采用输卵管牵引技术防止粘连。研究人员还检查了生育率和分娩结果。结论：与以往报道相比，经IPAA治疗的RPC术后生育能力有所改善，可能是由于预防了输卵管粘连。在装订IPAA后，VD是一种可行的选择，而CS并不仅仅是因为IPAA的历史而普遍需要。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.