Objective: 

Report the rate of successful pregnancy in a national cohort of women with either an ileal pouch anal (IPAA) or ileorectal (IRA) anastomosis constructed after colectomy for inflammatory bowel disease (IBD) or polyposis.

Background: 

Fertility after IPAA is probably impaired. All available data are corroborated by only small sample size studies. It is not known whether construction of IPAA versus IRA influences the odds of subsequently achieving a successful pregnancy, especially with increased utilization of the laparoscopic approach.

Methods: 

All women (age: 12–45 y) undergoing IRA or IPAA in France for polyposis or IBD, between 2010–2020, were included. A control population was defined as women aged from 12 to 45 years undergoing laparoscopic appendicectomy during the same period. The odds of successful pregnancy were studied using an adjusted survival analysis.

Results: 

A total of 1491 women (IPAA=872, 58%; IRA=619, 42%) were included. A total of 220 deliveries (15%) occurred during the follow-up period of 71 months (39–100). After adjustment, the odds of successful pregnancy was not significantly associated with type of anastomosis (after IPAA: Hazard Ratio [HR]=0.79, 95% confidence interval=0.56–1.11, P=0.17). The laparoscopic approach increased the odds of achieving successful pregnancy (HR=1.79, 95% confidence interval=1.20–2.63, P=0.004). IRA and IPAA significantly impacted fertility when compared with the control population (P<0.001).

Conclusions: 

In this large cohort study, total colectomy for polyposis or IBD was associated with reduced fertility compared with the general population. No difference in odds of achieving successful pregnancy was found between IRA and IPAA after adjustment. This analysis suggests laparoscopic surgery may be associated with greater likelihood of pregnancy.

中文翻译：

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与回肠直肠吻合术相比，回肠肛门吻合术是否会降低成功妊娠率？一项针对 1491 名患者的全国研究

 客观的：

报告全国妇女队列中因炎症性肠病 (IBD) 或息肉病而进行结肠切除术后进行回肠贮袋肛门 (IPAA) 或回直肠 (IRA) 吻合术的妇女的成功妊娠率。

 背景：

IPAA 后的生育能力可能会受到损害。所有可用数据仅通过小样本研究得到证实。目前尚不清楚 IPAA 与 IRA 的构建是否会影响随后成功妊娠的几率，特别是随着腹腔镜方法的使用增加。

 方法：

2010 年至 2020 年期间在法国因息肉病或 IBD 接受 IRA 或 IPAA 的所有女性（年龄：12-45 岁）均被纳入。对照人群定义为同期接受腹腔镜阑尾切除术的 12 至 45 岁女性。使用调整后的生存分析来研究成功怀孕的几率。

 结果：

共有 1491 名女性（IPAA=872，占 58%；IRA=619，占 42%）被纳入。在 71 个月的随访期间 (39-100) 总共发生了 220 例分娩 (15%)。调整后，成功妊娠的几率与吻合类型没有显着相关（IPAA 后：风险比 [HR]=0.79，95% 置信区间=0.56–1.11， P =0.17）。腹腔镜手术增加了成功妊娠的几率（HR=1.79，95%置信区间=1.20-2.63， P =0.004）。与对照人群相比，IRA 和 IPAA 显着影响生育能力( P <0.001)。

 结论：

在这项大型队列研究中，与一般人群相比，因息肉病或炎症性肠病而进行的全结肠切除术与生育力降低有关。调整后，IRA 和 IPAA 之间成功怀孕的几率没有差异。该分析表明腹腔镜手术可能与更大的怀孕可能性相关。