BACKGROUND: There is limited data on pouch outcomes after minimally invasive (MIS) proctectomy during ileal pouch-anal anastomosis (IPAA). This study aimed to determine if MIS proctectomy is associated with differences in pouch complications compared to open. METHODS: We performed a retrospective cohort study of patients from two academic institutions (2010-2022) who underwent restorative proctectomy with IPAA for inflammatory bowel disease, excluding those with Crohn's disease or Crohn's-like disease of the pouch. Patients were categorized into Open and MIS groups based on surgical approach. Perioperative outcomes and rates of pouchitis, cuffitis, and pouch failure were compared. Patient, disease, and operative factors associated with risk of pouch complications were identified using multivariable regression. RESULTS: 117 patients were included: 36 MIS and 81 Open. Median age at colectomy was 35 years, and 60% were male. Demographics, preoperative symptoms, medications, and surgical indications were comparable between groups. Rates of pouchitis (MIS 37% vs. Open 45%
p = 0.4), cuffitis (32% vs. 27%
p = 0.5), and pouch failure (5.6% vs. 6.2%
p >
0.9) were similar. MIS was associated with lower estimated blood loss (median 75 cc vs. 150 cc
p <
0.001). There were no differences in length of stay (MIS: 5 days vs. Open: 6 days
p = 0.2), operative time, or 30-day postoperative complications (HR 1.41
p = 0.5). There was a trend toward fewer anastomotic leaks in the MIS group (2.1% vs. 9.7%
p-0.2). On multivariable analysis, only initial colectomy for an indication of acute severe ulcerative colitis (HR 6.21
p = 0.044) and CONCLUSIONS: MIS proctectomy is associated with equivalent long-term pouch outcomes compared to open proctectomy. There may be a reduced risk of anastomotic leak with MIS and other perioperative outcomes were similar between groups. Patient and disease factors, but not operative factors, were associated with risk of pouch complications.