title: Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis.
abstract: BACKGROUND
  Posterior rectal dissection during ileal pouch-anal anastomosis (IPAA) can be performed in the total mesorectal excision (TME) or close rectal dissection (CRD) plane. The aim of this study was to compare morbidity and quality of life (QoL) in patients having TME or CRD during proctectomy followed by IPAA for benign disease.
  
  
  METHODS
  In this randomized clinical trial, patients undergoing IPAA were allocated to TME or CRD. Thirty-day morbidity was determined and QoL assessed using Short Form 36, GIQLI (GastroIntestinal Quality of Life Index) and COREFO (COloREctal Functional Outcome) questionnaires. The primary outcome (pouch compliance) of the trial is to be reported separately.
  
  
  RESULTS
  Fifty-nine patients were included, 28 in the CRD and 31 in the TME group. Baseline data were similar, except for more previous abdominal surgery in the TME group. Operating time was longer for patients having CRD (195 min versus 166 min for TME; P = 0·008). More patients in the TME group had a primary defunctioning ileostomy (7 of 31 versus 1 of 28 for CRD; P = 0·055). Severe complications occurred more frequently in the TME group (10 of 31 versus 2 of 28 for CRD). QoL was better in the CRD group for several subscales of the questionnaires measured at 1, 3 and 6 months after surgery. At 12 months, QoL was similar in the two groups for all subscales.
  
  
  CONCLUSIONS
  CRD led to a lower severe complication rate and better short-term QoL than wide TME.
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S A L
authors.initials: SA
authors.lastname: Bartels
authors.forename: T J
authors.initials: TJ
authors.lastname: Gardenbroek
authors.forename: M
authors.initials: M
authors.lastname: Aarts
authors.forename: C Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: C J
authors.initials: CJ
authors.lastname: Buskens
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000379:methods; D011788:Quality of Life; D012007:Rectum / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome