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Session:: ePosters-Sun225-M3: Inflammatory Bowel Disease

EP560 - Cesarean Section versus Vaginal Delivery for Patients with Ileal Pouch Anal Anastomosis: A Systematic Review

Sunday, May 10, 2026
2:30 PM - 2:35 PM ET

    ePoster Presenter(s)

  • Lucy N. Lan, MD

    Resident (PGY4)
    University of Toronto
    University of Toronto
    Toronto, ON, Canada

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    View ePoster

    • Author(s)

  • VB

    Vishali Balasubramaniam, MD

    General Surgery Resident
    University of Toronto
    Toronto, Ontario, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • Ad

    Anthony de Buck, MD, MSc

    Surgeon
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

Purpose/Background: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) for ulcerative colitis and certain hereditary colon cancer syndromes is often performed in women of reproductive age. Canadian consensus guidelines suggest consideration of C-section in those with IPAA based on limited retrospective data. However, C-section carries increased maternal risk, especially in patients with previous surgeries. This systematic review examines the existing evidence on the impact of delivery modality on IPAA function and quality of life.

Methods/Interventions: A systematic search of the existing literature was conducted on Medline, Pubmed, EMBASE, Cochrane, Web of Science, and Scopus for articles published on or before August 18, 2025. Titles and abstracts, and full-texts were screened by two independent reviewers. Eligible studies included non-diverted patients who delivered after IPAA surgery, and compared pouch function outcomes between patients with previous vaginal delivery (VD) and C-section (CS). Risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) score. Outcomes were extracted then narratively synthesized.

Results/Outcomes: Literature search yielded 4754 citations, resulting in 13 articles, totaling 558 patients, included for qualitative synthesis. The mean MINORS score was 16 ± 1 out of 24 for comparative studies, and 9 ± 5 out of 16 for non-comparative studies. The impact of delivery mode on IPAA function was the primary outcome in two studies, while it was reported as a secondary outcome in the remaining 11 studies. Stool continence was reported in 12 studies. None of the studies found a statistically significant difference in continence between CS and VD groups. Stool frequency was reported in seven studies, also without statistically significant difference between groups. Additional reported outcomes included small bowel obstruction, perineal tears, quality of life, and anal manometry. One study using endoanal ultrasound found that females were more likely to have anal sphincter defects after VD than CS. From reports of individual cases, more patients experience small bowel obstructions after CS than VD, and only patients in the VD group developed perineal tears.

Conclusion/Discussion: Current evidence does not demonstrate a clear difference in postpartum IPAA function in patients who undergo operative and vaginal delivery. However, the long-term clinical impact of sphincter injury and perineal tears after VD are unknown. Prospective studies using larger sample sizes, increased follow-up duration, and validated objective measures of pouch function are needed.

Table: Study Characteristics