Long-term adverse events such as perianal irritation, anastomotic stricture, desmoid formation, cancer in pouch/rectum, and need for further operation on the pouch (IPAA) or rectum (IRA) were reported by the ten studies shown in Table 3. It is important to note that further operation on the rectum after IRA involves excision of retained rectum and either proc-tectomy or secondary IPAA, whereas in the case of IPAA this involves either a redo IPAA or pouch excision and end ileostomy. The results from meta-analysis of post-operative complications from these studies are shown in the Forrest plot in Figure 2. Results significantly favouring IRA over IPAA included a reduced incidence of perianal irritation of 57.4% with IRA as compared to 62.7% with IPAA (OR=2.48, CI 1.36-4.55), and reduced incidence of anastomotic stricture formation of 2% with IRA vs. 8.1% following IPAA. Results significantly favouring IPAA over IRA included a reduced incidence of cancer in the pouch or retained rectum at 0% (0/187) following IPAA vs. 5.5% after IRA group (0R=0.13, CI 0.03-0.61), and a reduced need for further surgery to the pouch or rectum of 3.1% in the IPAA vs. 27.7% in the IRA group. There was no significant difference between IPAA and IRA groups in the incidence of intra-abdominal desmoids.
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