One- or Two-stage Procedure for Restorative Proctocolectomy: Rationale for a Surgical Strategy in Ulcerative Colitis

Overview

Journal Ann Surg

Specialty General Surgery

Date 2001 Dec 1

PMID 11729385

Citations 28

Authors

U A Heuschen

U Hinz

E H Allemeyer

M Lucas

G Heuschen

C Herfarth

Affiliations

Soon will be listed here.

Abstract

Objective: To analyze the results of different strategies for restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) in ulcerative colitis.

Summary Background Data: No commonly accepted criteria exist for choosing between the one-stage or the two-stage procedure (with or without temporary diverting ileostomy) for IPAA. The authors analyzed the outcome of patients principally suitable for either of the two alternative surgical strategies.

Methods: A matched-pair control study was performed, comparing surgical details and the early and late outcome of the one-stage (study group, n = 57) versus the two-stage procedure (control group, n = 114), for IPAA.

Results: No differences were found between the study group and the control group regarding the matching criteria gender, median age at IPAA, systemic corticoid medication, or activity of colitis. Comparing the patients who underwent a one-stage procedure with those who underwent a two-stage procedure, the proportion of patients without complications was significantly higher (P =.0042) and the frequency of late complications was significantly lower (P =.0022) in patients who underwent the one-stage procedure. The percentage of patients with anastomotic strictures was significantly higher in the control group than in the study group (P =.0022). No significant difference was found between the two groups regarding early complications, pouch-related septic complications, pouchitis, median duration of surgery for IPAA, median blood loss, need for transfusion, or median hospital stay.

Conclusions: In patients with ulcerative colitis in whom there is a choice between a one-stage procedure or a two-stage procedure with a defunctioning ileostomy, the one-stage procedure is clearly superior. This finding is of great clinical relevance both for the subjective interests of the patient and from an economic point of view.

Citing Articles

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Staging Pouch Surgery in Ulcerative Colitis in the Biological Era.

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Anastomotic Leak after Ileal Pouch-Anal Anastomosis.

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Risk factors for postoperative stoma outlet obstruction in ulcerative colitis.

Kitahara T, Sato Y, Oshiro T, Matsunaga R, Nagashima M, Okazumi S World J Gastrointest Surg. 2021; 12(12):507-519.

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Clinical Results of One-stage Restorative Proctocolectomy with J-pouch Anal Anastomosis in 300 Ulcerative Colitis Patients.

Kuwahara R, Ikeuchi H, Bando T, Sasaki H, Goto Y, Horio Y J Anus Rectum Colon. 2020; 4(4):181-185.

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