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Master Thesis

Impact de la réalisation d'une coloproctectomie totale avec anastomose iléo-anale sur la fertilité féminine : résultats d'une méta-analyse

Abstract : Background: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the gold standard surgery for ulcerative colitis (UC) with inefficient medical management and familial adenomatous polyposis (FAP) with high rectal involvement. Increased female infertility has been reported after IPAA but reported infertility rates are heterogeneous. The aim of this review was to to perform a systematic review and meta-analysis of the relative risk of infertility post-IPAA. Methods: all databases were searched independently by two investigators. The titles and abstracts of 88 potentially relevant studies were reviewed; seven met the criteria and all data were extracted independently. Consensus was achieved on each data point, and a random effects meta-analyses, a funnel plot, and sensitivity analyses were performed. Results: the weighted average infertility rate before IPAA was 18% (80/448) and 61% after IPAA (300/ 494). The relative risk of infertility after IPAA was 1,96 [1,44, 2.67] IC 95%. We were unable to identify any procedural factors that consistently affected the risk of infertility. The initial meta-analysis had significant heterogeneity I2 = 84%, sensitivity analysis identified one study with very high postoperative infertility (82%). When this study was omitted, the relative risk of infertility after IPAA was 1,64 [1,37-1,97] IC 95%, with non-significant heterogeneity I2=50%. Conclusions: IPAA increases the risk of infertility in women with UC and FAP. This twofold increased risk is a key data for the management of patients affected during their reproductive age. Fertility sparing should be discussed before surgery.
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Léopold Gaichies. Impact de la réalisation d'une coloproctectomie totale avec anastomose iléo-anale sur la fertilité féminine : résultats d'une méta-analyse. Médecine humaine et pathologie. 2019. ⟨dumas-02326572⟩

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