Comparison of single and double stapling anastomosis in restorative surgery for ulcerative colitis: short- and long-term outcomes and functional results.

Background: Ulcerative colitis (UC) often requires surgery, with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) considered the standard treatment. While the double-stapled (DS-IPAA) anastomotic technique remains commonly used, single-stapled (SS-IPAA) techniques, including transanal IPAA (ta-IPAA) and transanal transection with single-stapled anastomosis (TTSS), are gaining popularity. This study compares short-term, long-term, and functional outcomes between DS-IPAA and SS-IPAA in UC patients.

Methods: In this retrospective cohort study, 80 UC patients who underwent a three-stage restorative procedure at a single IBD referral center from June 2018 to June 2023 were analyzed. The patients were divided into two groups: Group 1 (40 DS-IPAA) and Group 2 (40 SS-IPAA, including ta-IPAA and TTSS). The key outcomes assessed included early and late postoperative complications, functional outcomes (measured using the Ileoanal Pouch Syndrome Severity Score, Low Anterior Resection Syndrome score, and IBDQ-32), and quality of life.

Results: The perioperative complications were similar between the groups. The SS-IPAA group had a significantly shorter hospital stay (6 vs. 8 days, p = 0.008). No significant difference in readmission rates was observed (7.5% DS-IPAA vs. 5.0% SS-IPAA, p = 0.644). The long-term results revealed a higher incidence of cuffitis in the DS-IPAA group (p = 0.002). The functional outcomes were significantly worse in DS-IPAA group, with worse IPSS scores (p = 0.003), higher incidence of major (37.5% vs. 17.5%, p = 0.007), and lower median IBDQ-32 (176 vs. 208, p < 0.001).

Conclusions: This study supports SS-IPAA as a favorable surgical option for UC patients, with implications for individualized surgical decision-making in specialized centers.