A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study.
OBJECTIVE
To assess the infertility rate after laparoscopic ileal pouch-anal anastomosis (IPAA).


BACKGROUND
Total proctocolectomy with IPAA is known to be associated with postoperative infertility in open surgery, which may be caused by pelvic adhesions affecting the fallopian tubes. However, fertility after laparoscopic IPAA has never been assessed.


METHODS
All patients who underwent a total laparoscopic IPAA between 2000 and 2011 and were aged 45 years or less at the time of operation and 18 years or more at the time of data collection were included. The patients answered a fertility questionnaire by telephone. All demographic and perioperative data were prospectively collected. The results were compared with those of controls undergoing laparoscopic appendectomy.


RESULTS
Sixty-three patients were included. The mean age at the time of surgery was 31 ± 9 years (range 14-44). IPAA was performed for ulcerative colitis in 73% of the cases and familial adenomatous polyposis in 17%. The mean follow-up after IPAA was 68 ± 33 months (range 6-136). Fifty-six patients answered the questionnaire (89%). Half of them already had a child before IPAA. Fifteen patients attempted pregnancy after IPAA, of which 11 (73%) were able to conceive, resulting in 10 ongoing pregnancies and 1 miscarriage. The global infertility rate was 27%. There was no difference in fertility over time compared with the 14 controls who attempted pregnancy during the same period (90% vs 86% at 36 months, P = 0.397).


CONCLUSIONS
The infertility rate appears to be lower after laparoscopic IPAA than after open surgery.
Department of Colorectal Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
Laura
L
Beyer-Berjot
Léon
L
Maggiori
David
D
Birnbaum
Jérémie H
JH
Lefevre
Stéphane
S
Berdah
Yves
Y
Panis
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult