Comparable perioperative outcomes, long-term outcomes, and quality of life in a retrospective analysis of ulcerative colitis patients following 2-stage versus 3-stage proctocolectomy with ileal pouch-anal anastomosis

  • Grace C. LeeEmail author
  • Sarah E. Deery
  • Hiroko Kunitake
  • Caitlin W. Hicks
  • Adriana G. Olariu
  • Lieba R. Savitt
  • Ashwin N. Ananthakrishnan
  • Rocco Ricciardi
  • Richard A. Hodin
  • Liliana G. Bordeianou
Original Article



Many surgeons assume 3-stage ileal pouch-anal anastomosis (IPAA) is safer than 2-stage IPAA in patients with active ulcerative colitis (UC), although recent data suggest outcomes are comparable. This study aimed to compare perioperative complications, late complications, and functional outcomes after 2- versus 3-stage IPAA in patients with active UC.


A retrospective review was conducted of patients who underwent 2- or 3-stage IPAA for active UC from 2000 to 2015 in a high-volume institution. Patients completed quality-of-life surveys 6 months following ileostomy reversal. Perioperative and late complications were recorded. Outcomes were compared with the Fisher exact test, and multivariable logistic regression was used to adjust for potential confounders.


We identified 212 patients who underwent 2- or 3-stage IPAA for active UC, of whom 157 patients (74.1%) underwent 2-stage procedures and 55 (25.9%) underwent 3-stage procedures. More patients undergoing 2-stage procedures were taking immunomodulators preoperatively (46.3% vs. 23.1%, p = 0.01), but there was no difference in use of steroids (p = 0.09) or biologic agents (p = 0.85). Three-stage procedures were more likely to be urgent (78.6% vs. 30.2%, p < 0.001). There were no differences in perioperative complications (p = 0.50), anastomotic leak (p = 0.94), pouchitis (p = 0.45), pouch failure (p = 0.46), perceived quality of life (p = 0.68), number of bowel movements per day (p = 0.27), or sexual satisfaction (p = 0.21) between the 2- and 3-stage groups.


Patients undergoing 2-stage compared to 3-stage IPAA for active ulcerative colitis have comparable outcomes and quality of life following ileostomy reversal. Two-stage IPAA appears to be safe and appropriate, even in high-risk patients.


Ulcerative colitis IPAA Two-stage Three-stage Quality of life 



GCL is currently receiving support from a National Institutes of Health T32 grant (Research Training in Alimentary Tract Surgery, DK007754-13).


GCL is currently receiving support from the National Institutes of Health T32 Research Training in Alimentary Tract Surgery grant DK007754-13.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For the data collection aspect of this study (Protocol #2008P002110), formal consent was waived by the IRB. For the survey portion of the study (Protocol #2011P001407), informed consent was implied by voluntary completion of the survey, as approved by the IRB.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Grace C. Lee
    • 1
    Email author
  • Sarah E. Deery
    • 1
  • Hiroko Kunitake
    • 1
  • Caitlin W. Hicks
    • 2
  • Adriana G. Olariu
    • 3
  • Lieba R. Savitt
    • 1
  • Ashwin N. Ananthakrishnan
    • 4
  • Rocco Ricciardi
    • 1
  • Richard A. Hodin
    • 1
  • Liliana G. Bordeianou
    • 1
  1. 1.Division of General and Gastrointestinal Surgery, Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of MedicineUniversity of North CarolinaChapel HillUSA
  4. 4.Division of Gastroenterology, Department of MedicineMassachusetts General HospitalBostonUSA

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