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ILEAL POUCH 2/15: TaTME-Pouch: What Are The Disadvantages?

Posted in Lectures on 1 August 2019

Peter Kienle, MD PhD
Chief of General and Visceral Surgery
Theresienkrankenhaus und St. Hedwig-Klinik
Mannheim, Germany

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In this video in the Ileal Pouch Series, Dr. Kienle talks about the disadvantages of TaTME.
Restorative proctocolectomy is indicated for treatment of inflammatory bowel diseases such as ulcerative colitis or in familial polyposis.
Only around 20% of cases require an oncological procedure, performing a total mesolectal excision.
In this video Dr. Kienle presents the disadvantages of TaTME-Pouch from his point of view.
There is no hard evidence on nerve damage, functional impact, or better anastomotic results, for taTME versus lapTME.
According to Dr. Kienle, making a purse-string to create an anastomosis is more difficult because if the purse-string is not tight, the risk of tissue and organ injury is higher due to impaired vision.
Dr. Kienle concludes that using taTME for a restorative proctocolectomy has no proven advantages, may be harmful and more expensive, but it is important to investigate further.

TaTME-Pouch: what are the disadvantages?

In terms of pouch function after TaIPAA
- Available data clearly demonstrate that transabdominal IPAA and TaIPAA have similar long-term results
- Available data clearly demonstrate a superiority of transabdominal TME compared with TaTME at long-term follow-up and results could be translated to TaIPAA
- One study comparing function after TaTME vs laparoscopic TME found a non-statistically significant but likely clinically relevant higher rate of major incontinence after TaTME, but the analysis includes all TaTME not TaIPAA only
TaTME and TaIPAA
- Can be easily reproduced and performed by skilled laparoscopic surgeons and a formal training is not required
- Have been associated with higher rates of complications compared with transabdominal surgery
- Are difficult procedures which require dedicated training and awareness of complications that are unusual with transabdominal approach
A single-stapled anastomosis (double-pursestring) with TaTME and TaIPAA
- Has been associated with increased complications and worse function compared with double-stapled anastomosis
- Increases the risk of dog-ears formation but similar anastomotic failure rates
- Requires knowledge and skills to appropriately preform it, but it might confer reduced risks of anastomotic complications

TaTME-Pouch: what are the disadvantages?

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