ORIGINAL ARTICLE Transanal completion proctectomy with close rectal dissection and ileal pouch-anal anastomosis for ulcerative colitis Katarina Levic Souzani, 1 Claus Buhl Nielsen 1 & Orhan Bulut 1,2 1 Gastrounit - Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark 2 Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Keywords: Ileal pouch-anal anastomosis; transanal proctectomy; ulcerative colitis Correspondence Orhan Bulut, Gastrounit - Surgical Division, Center for Surgical Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. Tel: +45 24 83 25 38 Email: orhan.bulut@regionh.dk Received 11 June 2018; revised 23 July 2018; accepted 7 August 2018 DOI: 10.1111/ases.12646 Abstract Introduction: Laparoscopic dissection in the pelvis is still a challenge. A transanal approach to rectal dissection allows better visualization during the dissection of the rectum and the creation of an anastomosis. Although initially used for patients with rectal cancer, the transanal approach may also have benefits in the surgical treatment of ulcerative colitis (UC). The aim of this study was to describe our initial experience with transanal com- pletion proctectomy and ileal pouch-anal anastomosis for UC. Methods: This study included all consecutive patients who underwent trans- anal completion proctectomy and ileal pouch-anal anastomosis for UC between September 2017 and February 2018. Results: Eleven patients were included in the study; they had a median age of 30 years (range, 13–51 years). The median operative time was 285 min (range, 190–375 min). There were no intraoperative complications or con- versions to open surgery. Postoperative complications occurred in only one patient (anastomotic leak), and the median length of hospital stay was 7 days (range, 5–37 days). Conclusion: Our initial experience with transanal completion proctectomy and ileal pouch-anal anastomosis shows promising results, demonstrating the feasibility of the transanal approach in patients with UC. Introduction Laparoscopic surgery has become the preferred surgical technique for most colorectal procedures. In patients with colorectal cancer, the use of laparoscopy has been found to reduce morbidity and to provide similar onco- logical outcomes to open surgery (1–3). The advantages of minimally invasive surgery in patients with ulcerative colitis (UC) and restorative proctocolectomy have also been addressed, with laparoscopy having been shown to improve short-term outcomes. Furthermore, in female patients treated with proctocolectomy for UC, those trea- ted laparoscopically have had higher pregnancy rates than those treated with an open approach (4–6). Laparoscopic dissection in the pelvis is, however, still a challenge, especially in male or obese patients. In an attempt to reduce conversion rates and improve func- tional and oncological outcomes, a transanal approach to rectal dissection has been developed, allowing better visualization during rectal dissection and anastomosis creation. Additionally, a transanal access offers better pelvic accessibility in patients with UC, resulting in the same technical improvements as in transanal total mesorectal excision (ta-TME) (7–9). In this pilot study, we describe our initial experience with transanal completion proctectomy and ileal pouch- anal anastomosis (ta-IPAA) in patients with UC. Methods From September 2017 to February 2018, 11 consecutive patients with UC underwent proctectomy and ileal pouch-anal anastomosis with the transanal approach. In all patients, laparoscopic colectomy with an end ileost- omy had previously been performed. Asian J Endosc Surg (2018) © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd 1 Asian J Endosc Surg ISSN 1758-5902