La kinésithérapie revêt différents aspects dans un service de chirurgie digestive. Le massage abdominal peut en être un point essentiel. Celui-ci est utilisé depuis de nombreuses années dans notre service, chez des patients opérés et dès le premier jour postopératoire. En dehors d’un tableau de péritonite aiguë ou d’occlusion organique, il n’y a pas, pour nous, de contre-indication formelle au massage abdominal dans cette situation. Nous avons réalisé une vidéo d’un tel massage abdominal chez une patiente opérée la veille pour occlusion de l’intestin grêle par laparotomie. Cet article et cette vidéo ont été conçus pour donner un aperçu des manoeuvres utilisées dans le service chez certains patients opérés en chirurgie colorectale. Cette patiente avait reçu les informations sur le massage et avait signé un consentement d’exploitation et de reproduction de l’image. Niveau de preuve NA.

BACKGROUND:We aim to assess the surgical and oncological outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in upper rectal peritoneal metastases (U_PM) versus middle/lower rectal peritoneal metastases (ML_PM). METHODS:Between January 2013 and March 2024, Data from 101 patients with rectal peritoneal metastases who underwent CRS with or without HIPEC were analysed (U_PM, n = 68; ML_PM, n = 33). Day-30 morbi-mortality, overall survival (OS) and recurrence-free survival (RFS) were compared. RESULTS:Among 101 patients included, the median age was 58 years and 52.5% were women. Initial PCI score median was 6 [3; 13]. The U_PM group had longer surgery time (420 vs 370 min; p = 0.029). Surgical outcomes including postoperative complications, reoperation rate, ICU and hospital stays were not significantly different between U_PM and ML_PM groups. Severe complications (Dindo-Clavien 3-4) and death rates were similar between the two groups: (64.3% vs 75%; p = 0.399) and (1.5% vs 0%; p = 1.000); respectively. The 3-year and 5-year OS rates were 59.7% and 42% respectively and were significantly better for U_PM than for ML_PM patients: (68.1% vs 42.9%; p = 0.039) and (48.2% vs 32.2%; p = 0.044) respectively. Multivariable Cox proportional hazards analysis of survival up to 5 years identified ML_PM (HR = 1.93), PCI score (HR = 1.10) and HIPEC procedures with oxaliplatin (HR = 2.93) as significant risk factors of death. The 3 and 5-years RFS were similar between groups (p = 0.318) and (p = 0.376); respectively. CONCLUSION:Patients presenting with upper rectal PM who underwent CRS with or without HIPEC have similar surgical outcomes except total surgery time and have significantly better OS at 3 and 5 years than patients with middle/lower rectal PM. RFS at 3 and 5 years was comparable between the two groups. Middle/Lower origin and PCI score were identified as significant risk factors of death. The primary tumor location of patients with rectal PM is an important factor that should not be underestimated. Larger prospective studies are required to confirm findings.

We conducted a retrospective study of all consecutive patients operated for rectal cancer with LAR and coloanal anastomosis in our tertiary center to compare the occurrence of LAR syndrome (LARS) more than 1 year after surgery between patients treated with DCAA and those with ICAA. Secondary objectives were to compare post-operative complications at 90 days. From 2010 to 2022, 139 patients underwent LAR (ICAA, n = 45; DCAA, n = 25) with coloanal anastomosis for rectal cancer in our department. Long-term bowel function after LAR and post-operative outcomes were compared. After a median follow up of 48 months, the mean LARS score in the population (36 patients) was 32 (26; 37). The mean LARS score was significantly lower in the DCAA group (29 vs. 38; p < 0.001). A statistically significant association was found between the ICAA group and the LARS score, both in univariate and multivariate analysis adjusted on sex, age, BMI and ASA score; respectively (OR Beta = 9.9 [4.1–16]; p = 0.001) and (OR Beta = 10 9.5 [4.3–16]; p = 0.0032). The complication rate 90 days following surgery was 47

BACKGROUND:Organ preservation strategies, including watch and wait and local excision, are increasingly adopted in rectal cancer management. Total neoadjuvant therapy improves complete response rates, potentially expanding organ preservation indications. OBJECTIVE:This study aims to evaluate the real-world implementation of organ preservation strategies and short-term oncologic outcomes in patients with nonmetastatic mid- and low-rectal cancer in France. DESIGN:Prospective, multicenter, observational cohort study. SETTINGS:Twenty-seven French Groupe de RECherche sur le CAncer ColoRectal centers were included. PATIENTS:Patients with biopsy-proven, nonmetastatic rectal adenocarcinoma (<12 cm from anal verge) treated with neoadjuvant therapy managed with organ preservation intent across 27 French Groupe de RECherche sur le CAncer ColoRectal centers (October 2022-March 2023) were included. Patients were categorized into selective (early stage) or opportunistic (advanced stage) strategies and managed with either watch and wait or local excision. MAIN OUTCOME MEASURES:The main outcome measures were rates of organ preservation, watch and wait versus local excision use, and oncologic outcomes at 1 and 2 years, including overall survival, disease-free survival, local recurrence-free survival, total mesorectal excision-free survival, and distant metastasis. RESULTS:Of the 457 patients, 117 (26%) underwent organ preservation, more frequently with the selective strategy (51% vs 18.1%; p < 0.001). Watch and wait was the predominant organ preservation method (78% vs 22%) and was used similarly across both groups ( p = 0.728). Total neoadjuvant therapy was the most common neoadjuvant regimen (67%), predominantly via induction chemotherapy (56%). Overall 2-year survival exceeded 95% across groups. No significant differences were found between watch and wait and local excision in disease-free survival, local recurrence-free survival, or total mesorectal excision-free survival. Local regrowth occurred in 14 watch and wait patients and in 3 patients after local excision, mostly within the first year, with salvage surgery successfully performed. Distant metastases were more frequent in patients treated under the opportunistic strategy. LIMITATIONS:The short follow-up period limits the assessment of long-term outcomes and late recurrences. CONCLUSIONS:In this nationwide French cohort, organ preservation strategies-supported by total neoadjuvant therapy-were feasible and safe across tumor stages. Both watch and wait and local excision demonstrated comparable short-term oncologic outcomes, supporting their roles as viable options within individualized, response-adapted treatment pathways. See Video Abstract . PRESERVACIN DE RGANOS EN EL TRATAMIENTO DEL CNCER DE RECTO UNA PERSPECTIVA PROSPECTIVA DEL ESTUDIO GRECCAR:ANTECEDENTES:Las estrategias de preservación de órganos, incluyendo la observación y espera y la escisión local, se adoptan cada vez más en el manejo del cáncer de recto. La terapia neoadyuvante total mejora las tasas de respuesta completa, lo que podría ampliar las indicaciones de preservación de órganos.OBJETIVO:Evaluar la implementación en la práctica clínica de las estrategias de preservación de órganos y los resultados oncológicos a corto plazo en pacientes con cáncer de recto medio e inferior no metastásico en Francia.DISEÑO:Estudio de cohorte prospectivo, multicéntrico y observacional.ÁMBITO:Se incluyeron veintisiete centros GRECCAR franceses.PACIENTES:Se incluyeron pacientes con adenocarcinoma de recto no metastásico confirmado por biopsia (<12 cm del margen anal) tratados con terapia neoadyuvante con intención de preservar el órgano en 27 centros GRECCAR franceses (octubre de 2022 a marzo de 2023). Los pacientes se clasificaron en estrategias selectivas (estadio temprano) u oportunistas (estadio avanzado) y se manejaron con observación y espera o escisión local. Principales medidas de resultado: Tasas de preservación de órganos, observación y espera frente a escisión local, y resultados oncológicos a 1 y 2 años, incluyendo supervivencia global, supervivencia libre de enfermedad, supervivencia libre de recurrencia local, supervivencia libre de escisión total del mesorrecto y metástasis a distancia.RESULTADOS:De los 457 pacientes, 117 (26%) se sometieron a preservación de órganos, con mayor frecuencia mediante la estrategia selectiva (51% frente a 18,1%; p < 0,001). La observación y espera fue el método predominante de preservación de órganos (78% frente a 22%), utilizado de forma similar en ambos grupos (p = 0,728). La terapia neoadyuvante total fue el régimen neoadyuvante más común (67%), predominantemente mediante quimioterapia de inducción (56%). La supervivencia global a los 2 años superó el 95% en ambos grupos. No se observaron diferencias significativas entre la observación y espera y la escisión local en la supervivencia libre de enfermedad, la supervivencia libre de recurrencia local ni la supervivencia libre de escisión total del mesorrecto. Se observó recidiva local en 14 pacientes del grupo de observación y espera, y en 3 tras la escisión local, principalmente durante el primer año, realizándose con éxito una cirugía de rescate. Las metástasis a distancia fueron más frecuentes en los pacientes tratados con la estrategia oportunista.LIMITACIONES:El corto periodo de seguimiento limita la evaluación de los resultados a largo plazo y las recidivas tardías.CONCLUSIONES:En esta cohorte francesa a nivel nacional, las estrategias de preservación de órganos -apoyadas por terapia neoadyuvante total- resultaron factibles y seguras en todos los estadios tumorales. Tanto la observación y espera como la escisión local demostraron resultados oncológicos a corto plazo comparables, lo que respalda su papel como opciones viables dentro de las vías de tratamiento individualizadas y adaptadas a la respuesta. (AI-generated translation ).

AIM:Neoadjuvant treatment for rectal cancer has evolved markedly with the growing adoption of total neoadjuvant therapy (TNT), organ-preservation strategies and selective omission of radiotherapy. Recent trials support risk-based personalization, but its application in real-world settings remains poorly documented. The aim was to describe current neoadjuvant treatment practices for mid-low rectal cancer in French expert centres and identify tumour- and patient-related factors influencing decisions. METHOD:This observational study included patients with non-metastatic rectal adenocarcinoma ≤10 cm from the anal verge, discussed in tumour boards (October 2022 to March 2023) across GRECCAR centres. Tumours were classified as early, intermediate-risk or locally advanced rectal cancer (LARC). Neoadjuvant treatments were analysed according to tumour extension, location and age. RESULTS:Among 463 patients from 27 centres, the most frequent regimen was induction chemotherapy, mainly FOLFIRINOX, followed by long-course chemoradiotherapy (CRT) (65%). This approach was used in 51%, 66% and 71% of patients in the early, intermediate-risk and LARC groups, respectively (p = 0.0060). TNT was more frequently administered for low- than mid-rectal cancers, especially in LARC (86% vs. 71%, p = 0.016). In patients >75 years, CRT + consolidation chemotherapy and radiotherapy alone were proportionally more frequent. Among the early rectal cancers, those treated with induction chemotherapy + CRT had more advanced features than those treated with CRT alone (cT3: 80% vs. 43%, cN+: 62% vs. 10%, tumour size: 3.4 vs. 2.3 cm; all p < 0.001). CONCLUSION:TNT with induction chemotherapy is the predominant neoadjuvant approach in French expert centres. Tumour classification, location and patient age significantly influence treatment choices, reflecting a shift towards personalized context-specific care.

BACKGROUND:Obstructive colon cancer (OCC) is at poor prognosis, and the high morbidity of emergency resection frequently delays or precludes adjuvant chemotherapy. A strategy with first step diverting stoma - neoadjuvant chemotherapy (NAC) - colectomy in non-metastatic OCC may represent an alternative to the conventional strategy of stoma followed by colectomy. METHOD:COnCERTO is a multicenter, open-label, randomized (1:1), phase III trial evaluating NAC followed by colectomy ± adjuvant chemotherapy versus standard-of-care colectomy ± adjuvant chemotherapy in adults with resectable non-metastatic MSS OCC first treated by a defunctionning stoma. Two hundred and thirty-two will be randomized across 37 French centers. The primary endpoint is the rate of complete curative therapeutic sequence combining the resection of the primary and the administration of scheduled NAC and/ or adjuvant chemotherapy. Secondary endpoints include the tolerance and compliance of NAC and/ or adjuvant chemotherapy (SRAE ≥ grade 3, CTCAE v5.0), quality and completeness of the surgical excision, 90 days postoperative morbidity, health-related quality of life, OS and DFS at 3 years and survival without stoma at 3 years. Randomization started in May 2024. DISCUSSION:COnCERTO will determine whether a NAC approach can be pursued safely and effectively in localized OCC and translate into a better cancer control and quality of life improvement. REGISTRATION NUMBER:ClinicalTrials.gov NCT06107920.

BACKGROUND:Several publications have shown that cancers of the colon and of the rectum are significantly different, and tumor location is a major prognostic factor for survival. However, colorectal peritoneal metastases (CRPM) is still considered as a homogeneous and a single disease without differentiating between colonic or rectal origin. We asked whether the primary tumor location influences the survival and surgical outcomes of patients with colonic (C_PM) and rectal peritoneal metastases (R_PM) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS:Between January 2013 and March 2024, data from 1237 CRS/HIPEC procedures in 1152 patients with CRPM were analysed (C_PM, n = 1129; R_PM, n = 108). Overall survival (OS), recurrence-free survival (RFS), and day-30 morbi-mortality were compared. RESULTS:The 3-year and 5-year OS rates were 68.9% and 52.5% respectively and were significantly better for C_PM than for R_PM patients: (69.8% vs 61%; p = 0.036) and (53.4% vs 43.6%; p = 0.031) respectively. Stratification according to left (LC_PM) and right colonic (RC_PM) subgroups resulted in better 3-year OS for LC_PM than for RC_PM (73.9% vs 63.2%; p ≤ 0.001). Multivariate analysis of 5-year survival identified PCI >15 (HR = 2.09), R_PM (HR = 1.46) and RC_PM (HR = 1.29) as significant risk factors of death. The C_PM group had fewer re-interventions at day-30 (17.6% vs 36.1%; p ≤ 0.001) and shorter surgery time (330 vs 390 min; p ≤ 0.001), ICU-stay (3 vs 4 days; p ≤ 0.001) and hospital length-of-stay (14 vs 17 days; p = 0.002). CONCLUSION:Patients presenting with colonic PM have significantly better OS at 3 and 5 years with fewer re-interventions at day-30 and, shorter surgery time, ICU and hospital stay than those presenting rectal PM. Left-side colonic PM has a significantly better OS at 3-years than right-side colonic PM. PCI >15, rectal and right colonic origin are linked to earlier mortality. When deciding on CRS/HIPEC treatment, designing a study, or reporting data, the CRPM primary tumour site should be taken into account.

BACKGROUND:Bladder drainage is systematically used in rectal cancer surgery in male patients, even in the era of enhanced recovery after surgery (ERAS). However, little data is available on risk factors for urinary tract infection (UTI). Identifying the risk factors associated with UTI within 4 days of male rectal cancer surgery in an ERAS program could support more individualized decision-making. METHODS:We used data from the GRECCAR 10 randomized clinical trial, a comparison of outcomes of transurethral catheterization (TUC) or suprapubic catheterization (SPC). 240 patients were randomized, 209 retained in the study (TUC n = 99; SPC n = 109). Univariate and multivariate logistic regression post-hoc study analyses were performed to assess association between potential predictive factors and UTI within 30 days after surgery. RESULTS:Out of 208 patients (median age 64.5 years), 19 (9.1%) had UTI, 26 (12.5%) had bacteriuria and 145 (69.7%) had pyuria. Univariate analysis identified age ≥ 65 years (OR = 3.08 [1.07-8.89]; p = 0.038), hypertension (OR = 3.65 [1.23-10.84]; p = 0.020) and ASA score ≥ 3 (OR = 4.15 [1.53-11.2]; p = 0.005) as risk factors for UTI until POD4. Multivariate analysis identified ASA score ≥ 3 with a risk of UTI. CONCLUSION:Regarding male rectal cancer surgery, our study shows that nearly 1 in 10 patients had UTI within 4 days. An ASA score ≥ 3 is an independent risk factor linked to UTI. Identifying this risk factor for UTI is necessary to advise patients, support a tailored decision-making process, and prevent these complications.

BACKGROUND:Standard treatment for resectable peritoneal metastasis (PM) includes the combination of cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Postoperative evisceration is a rare but major complication after CRS and HIPEC. This study aimed to identify the risk factors associated with evisceration after HIPEC, comparing outcomes between open and closed abdominal HIPEC. METHODS:We conducted a retrospective multi-center study analyzing data of 233 patients with PM who underwent CRS/HIPEC between 2014 and 2023. Patients were categorized based on the HIPEC technique: Open (OPEN_HIPEC), n = 110; Closed abdominal technique (CLOSED_HIPEC), n = 123). We aimed to identify patient factors associated with evisceration within 30 days of CRS/HIPEC, using multivariate analysis. RESULTS:Among 233 patients included, 129 (55.4 %) were women. The median age was 60 [51; 67] years. The OPEN_HIPEC group was significantly younger than the CLOSED_HIPEC group (median 57 [47; 62] vs 63 [54; 70] years; p ≤ 0.001) with a higher PCI score (median 9.5 [5; 17] vs 6 [2; 11]; p ≤ 0.001). Severe complications were similar between OPEN and CLOSED_HIPEC: 17 (15.5 %) vs 15 (12.2 %); p = 0.471 with no mortality. Eight (3.4 %) patients had postoperative evisceration with significantly more occurrences in the OPEN_HIPEC than in the CLOSED_HIPEC group (7/110 (6.4 %) vs 1/123 (0.8 %); p = 0.028). Univariate analysis identified chronic obstructive pulmonary disease (COPD)/respiratory pathology (HR = 7.02 [1.76-28.1]) and PCI score category of 11-15 (HR = 5.09 [1.03-25.2] as risk factors. Multivariate analysis identified a history of COPD/respiratory pathology (HR = 7.39 [1.85-29.6], p = 0.005) and OPEN_HIPEC (HR = 8.37 [1.03-68.1], p = 0.047) as risk factors of postoperative evisceration. Although suture material was not identified as a significant factor by the analysis, all eviscerations in the OPEN_HIPEC group were observed following musculoaponeurotic closures using Vicryl 1 sutures. CONCLUSIONS:Following CRS/HIPEC treatment, 3.4 % patients had evisceration by day 30. A history of COPD/respiratory pathology and OPEN_HIPEC technique were identified as independent risk factors associated with evisceration, necessitating reintervention. It should also be noted that in the OPEN_HIPEC group there were no eviscerations after the change to PDS sutures.

Patients undergoing bowel resection with anastomosis experience postoperative impaired gastrointestinal motility, sometimes leading to symptoms such as nausea, vomiting, bloating, delayed passage of flatus and stools, and inability to tolerate solid food. We determined the times for recovery of gastrointestinal motility (in minutes) following intestinal resection with anastomosis. We used data from the MATRAC randomized clinical trial, a comparison between outcomes of a standard ERAS group and an ERAS plus massage group. 36 patients were randomized, 35 retained in the study (standard ERAS n = 16; ERAS plus massage n = 19). Solid foods are tolerated after a median of about 3 h after small bowel resection, and medians of approximately 16 and 14 h after right and left colon resection, respectively. The first flatus appeared approximately 16, 44 and 17 h after resection of the small bowel, right colon and left colon, respectively. In other words, first flatus is expected during the first postoperative day following small bowel and left colon resection, and during the second postoperative day following right colon resection. The first stool appears approximately 36, 70 and 46 h after small bowel, right colon and left colon resection, respectively. We found that the shortest recovery time was observed following small bowel resection, and the longest in patients who underwent right colectomy. The same evolution was observed for the resumption of flatus, defecation and solid food intake, taken separately.

Laparoscopic ventral mesh rectopexy (LVR) has gained increasing acceptance for the treatment of patients with a full-thickness rectal prolapse (RP), but literature on follow-up of at least 10 years is scarce. We studied recurrence rate, long-term functional results and quality of life in patients who had LVR for RP more than 12 years ago. The study population consisted of patients who could be contacted among the 175 who had undergone LVR for RP and whose short- and medium-term outcomes were published in 2012. We studied the long-term recurrence rate (Kaplan-Meier), functional outcome (Wexner and ODS scores), quality of life (EuroQol) and satisfaction of the patient through clinical examination(s), specific scores and questionnaires. Of the 175 patients, 14 patients had exclusion criteria, 57 had died, and 42 were lost to follow-up, leaving 62 patients for analysis. Seventeen patients presented with a recurrence (10.5

BACKGROUND:Complete cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for patients with peritoneal metastases. In this retrospective observational two-center study, we assessed the impact of patient's body mass index (BMI) on surgical and oncological outcomes. METHODS:Between 2017 and 2021, 144 patients with peritoneal metastases (all etiologies) were included. Morbi-mortality at day-30, overall survival and free-recurrence-survival were compared according to the patients BMI. The patients were divided into 2 groups (BMI < 25, and BMI ≥ 25). RESULTS:Median overall survival (OS) was 71.3 months [63-71.5], with significant differences observed between BMI groups (p = 0.015). Recurrence-free survival (RFS) averaged 26.8 months [20-35.3] and did not significantly differ between groups (p = 0.267). After stratification by histology, OS and RFS remained consistent. Cox multivariate analysis adjusted for Peritoneal Carcinomatosis Index (PCI) revealed BMI < 25 (HR = 2.53 [1.10-5.80]) and male sex (HR = 2.34 [1.11-4.92]) as predictors of poorer OS. 30-Day complication rates did not significantly differ (p = 0.094). The BMI ≥ 25 group experienced higher rates of digestive fistulas (p = 0.05) and 90-day readmissions (p = 0.007), although reintervention rates were comparable (p = 0.723). CONCLUSIONS:Our study suggests a potential 'obesity paradox' in the context of HIPEC procedures. Morbidity at day-30 was similar for BMI < 25, and BMI ≥ 25 patients. Readmissions at day-90 were more frequent in high-BMI group. BMI < 25 is deleteriously associated with mortality. BMI and sex were related to OS.

La enfermedad de Crohn se complica frecuentemente con una afectación anoperineal, cuya incidencia es variable en la literatura. En todos los casos, su presencia constituye una complicación grave, ya que tiene una repercusión importante sobre la calidad de vida. Además de las lesiones inflamatorias difusas y de la lesión primaria, que es la ulceración, hay que identificar las complicaciones secundarias, cuyo tratamiento es mixto, medicoquirúrgico. El cirujano interviene de urgencia para drenar un absceso y, a menudo, colocar un drenaje con sedal, ya que una fistulotomía conllevaría un riesgo demasiado elevado de incontinencia por sección del esfínter. También puede intervenir en las complicaciones crónicas. Una fístula anorrectal puede tratarse mediante drenaje con sedal prolongado si el trayecto es alto o mediante fistulotomía si el trayecto es transesfinteriano bajo o subcutáneo. Las recidivas suelen requerir una consulta especializada, porque puede ser necesario establecer la indicación de la mejor técnica posible según diversos criterios, como el grado de inflamación, la localización de los orificios, el trayecto de la fístula, la calidad del esfínter, el número de fístulas y la asociación posible a una estenosis más o menos o larga. Se dispone de varios métodos quirúrgicos para tratar una fístula inactiva: colgajo de descenso rectal, inyección de adhesivo biológico, inserción de un tapón (plug), ligadura interesfinteriana del trayecto fistuloso, colocación de un clip, inyección de células mesenquimatosas autólogas o no, realización de un colgajo de Martius o de grácil. Una estenosis anorrectal requiere dilataciones repetidas y, en caso de recidiva, el especialista valorará la indicación de una plastia. En algunos casos de enfermedad de Crohn avanzada, es posible que se proponga al paciente una ostomía temporal, incluso definitiva si las lesiones se consideran graves e irreversibles. El carácter crónico e invalidante de la afección, así como la multiplicidad de tratamientos propuestos para una misma lesión obligan a tener en cuenta la opinión del paciente sobre el tratamiento, que será medicoquirúrgico, pues se le suelen ofrecer varias soluciones, con una eficacia, complicaciones y secuelas variables.

Primary anastomosis with a diverting stoma (PA) has been evaluated relative to Hartmann's procedure (HP) for Hinchey III/IV peritonitis in four randomized trials, all of which lacked power. We aimed to evaluate the safety of PA for this indication in real-life settings. Patients who underwent surgery for Hinchey III/IV diverticulitis at 43 French centers from 2010 to 2021 were included in this retrospective multicenter study. The primary endpoint was the rate of severe complications at 90 days (Clavien-Dindo III-V). Secondary endpoints included the overall complication rate and stoma-free survival at one year. Two groups of patients (PA vs. HP) were created by propensity score matching (PSM). In total, 651 patients were included (112 with PA and 539 with HP). We matched 102 of the patients with PA with 102 patients who underwent HP. On day 90, there was no difference in the rate of severe complications (31

BACKGROUND AND AIMS:Total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for patients with ulcerative colitis refractory to medical therapy. While its impact on bowel function is well documented, its effects on sexual function remain controversial. This study aimed to evaluate changes in sexual function, psychological outcomes (anxiety, depression and fatigue) and quality of life (QoL) after surgery. METHODS:This prospective multicentre cohort study included patients undergoing IPAA. Sexual function was assessed using the IIEF-5 (men) and FSFI (women). Psychological status, fatigue and QoL were evaluated using the HADS, FSS and SIBDQ, respectively. Validated patient-reported outcome measures were collected at baseline and 6-12 months postoperatively. RESULTS:A total of 332 patients were included. Male sexual function remained stable: 50% reported erectile dysfunction (ED) at baseline with no significant change postoperatively. Female sexual function improved significantly, particularly in desire (p = 0.002) and arousal (p = 0.003). Anxiety and depression (HADS) decreased significantly over time (p < 0.001), as did fatigue (FSS ≥4 dropping from 43% to 25%, p = 0.004). QoL improved markedly, with the proportion of patients reporting poor QoL (SIBDQ <45) reduced threefold at 12 months (p < 0.001). Depressive symptoms were strongly associated with ED in men (OR = 14.46, p = 0.021), while disease extent had no significant effect on sexual function. CONCLUSIONS:IPAA was associated with significant improvement in psychological well-being, fatigue and QoL, with notable improvements in sexual function among women. However, persistent sexual dysfunction-particularly in women and in men with depressive symptoms-underscores the need for tailored psychological support in the perioperative period.