National Trends of 3- Versus 2-Stage Restorative Proctocolectomy for Chronic Ulcerative Colitis

Abstract

National trends of 2- versus 3-stage IPAA have remained stable over the last 5 years. Patients who underwent a 3-stage approach were healthier at the time of pouch surgery, with decreased corticosteroid use, hypoalbuminemia, and weight loss. Mixed results were seen for infectious complications with either approach. Prospective research is needed to determine the best approach to IPAA for chronic ulcerative colitis.

Systematic review: outcomes and post‐operative complications following colectomy for ulcerative colitis

“…Hand‐searches of conference proceedings and of reference lists yielded six additional studies. The SR update yielded three further studies . In total, 28 studies were included: 27 non‐RCTs and one RCT.…”

“…More than half of the 28 studies included were conducted in the USA ( n = 17) with the remaining studies being conducted worldwide, including Japan ( n = 4) and Denmark ( n = 2) …”

“…Thirteen retrospective studies analysing 4818 patients with UC, reported the outcome of ‘any’ complication, defined as the occurrence of ≥1 complications in an individual patient during the study follow‐up period. The occurrence of ‘any’ early complication ranged from 52/550 (9%) in one study of patients undergoing three‐stage IPAA to 39/60 (65%) in a study of patients undergoing laparoscopic IPAA . The reported occurrence of ‘any’ late complication ranged from 10/60 (17%) to 38/68 (55%) …”

“…Eleven studies analysing 5196 patients with UC reported post‐operative mortality data. Of the eleven studies, eight reported the incidence of mortality within 30 days from the colorectal procedure, two reported mortality post‐operatively (one reported mortality as in‐hospital complication), one as a long‐term complication – within 60 days after first operation, and one study did not report details on time of patients’ death . Mortality rates ranged from 0 (0%) to 16/559 (2.9%), with a mean incidence of 1.0% across all included studies.…”

The Authors Reply

“…3 Again, this is clearly vital but unavailable from the data set we used. 3 the authors have also rightly pointed out the lack of information on the dose of steroids used preoperatively in our study.…”