Pediatric ulcerative colitis: three- versus two-stage colectomy with ileal pouch-anal anastomosis
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Despite advancements in medical therapy for ulcerative colitis (UC), a significant proportion of children progress to colectomy with ileal pouch-anal anastomosis (IPAA). Procedural related complications between two- and three-stage operations in children have not been well described.
We performed a retrospective review of patients who underwent a colectomy for UC or inflammatory bowel disease unclassified between 2008 and 2018.
Forty-nine children underwent an IPAA at the time of colectomy (two stage) or during a subsequent operation (three stage). Preoperative hemoglobin and albumin concentrations were lower among those undergoing three-stage procedures. The rate of early complications (≤30 days) was similar between the two groups (p = 0.46); however, late complications (>30 days) were more commonly associated with three-stage procedures (p = 0.03). Time with a stoma was 3.2 months longer among those who underwent a three-stage procedure. While three-stage procedures were more often performed during the first half of the study period (2008–2012), two-stage procedures became more common during the second half (2013–2018). During this transition to favor two-stage procedures, complication rates did not significantly change.
Although three-stage procedures were thought to be associated with fewer complications, we found comparable complication rates as we transition to two-stage procedures.
KeywordsUlcerative colitis Indeterminant colitis Inflammatory bowel disease unclassified Ileal pouch-anal anastomosis Two-stage procedure Three-stage procedure Complications
Compliance with ethical standards
Conflict of interest
No authors have a conflict of interest to disclose.