title: Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study.
abstract: OBJECTIVE
  To assess the impact of a laparoscopic approach on female fecundity in ileoanal pouch surgery.
  
  
  BACKGROUND
  Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is associated with tubal factor infertility in female patients. Different studies showed less adhesion formation after laparoscopic colectomy. The relation between laparoscopic pouch surgery and fertility, however, has not been studied so far.
  
  
  METHODS
  This cross-sectional study was carried out in 3 university hospitals in the Netherlands and in Belgium. Female patients older than 18 years that had IPAA under the age of 41 were eligible for inclusion (n = 179). We sent them a questionnaire addressing medical and fertility history. The primary endpoint was time to first spontaneous pregnancy after IPAA. This study has been registered with ISRCTN.org (ISRCTN85421386).
  
  
  RESULTS
  Of 179 eligible patients, 160 (89%) returned the questionnaire. After IPAA, 50 (31%) patients attempted to conceive. Of these, 23 (46%) had undergone open and 27 (54%) had undergone laparoscopic IPAA. Patient characteristics were similar in both groups. Indications for surgery were ulcerative colitis (UC) in 37 patients, familial adenomatous polyposis (FAP) in 12 patients, and colonic ischemia in 1 patient. A Kaplan-Meier survival function was plotted for time to first spontaneous pregnancy and showed a higher pregnancy rate after laparoscopic IPAA (log-rank, P = 0.023). Similarly, subsequent survival analysis for all patients with UC showed an increased pregnancy rate for the laparoscopic group (log-rank, P = 0.033).
  
  
  CONCLUSIONS
  Pregnancy rates are significantly higher after laparoscopic IPAA. This makes the laparoscopic approach the method of choice in young women.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sanne A L
authors.initials: SA
authors.lastname: Bartels
authors.forename: André
authors.initials: A
authors.lastname: DʼHoore
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Bensdorp
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D039021:Colonic Pouches; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D016737:Proctocolectomy, Restorative / Q000379:methods*