Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients

Abstract

Our study suggested that postoperative morbidity was similar between two- and three-stage laparoscopic IPAA. It suggested that the three-stage procedure is probably safer for high-risk patients [ie in acute colitis].

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

“…Prior studies comparing 2-versus 3-stage operations have been conducted, however most are retrospective studies based on small cohorts from single-institutions. [23][24][25][26][27] Two studies combined patients with UC and familial adenomatous polyposis, [24,26] and three were published over 25 years ago. [23][24][25] More recent data suggests no difference in complications or rates of abdominal sepsis after 2-versus 3-stage IPAA.…”

Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

“…The lack of such long-term benefits should be discussed with patients when proposing a laparoscopic approach [14]. Mege et al looked at laparoscopic IPAA performed in a two-or three-staged fashion and revealed no statistical difference in outcomes between these approaches [1,4,7,15]. It should be emphasized that, even if laparoscopic techniques are used for colorectal dissection and resection, pouch construction and the anastomosis are usually done by hand although with a small lower abdominal incision.…”

Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results

“…The results from the group of Clichy, who used laparoscopy in 100% of 185 patients, are very similar to the results in this study, in particular in terms of patient characteristics, operative findings, perioperative complications and postoperative results (Table 1 and 2). However, some interesting differences should be highlighted 65 .…”

“…Morbidity is subject to the same prognostic factors of mortality and remains quite high in almost all the series. Expected morbidity ranges from 25% to 65%, but major complications have shown a tendency to decrease over years, in particular after laparoscopic procedures performed in referral centers 6,11,47,59,65 . In most studies, complications are reported as a description, limiting the possibility of adequate comparisons.…”

“…Determining the right timing for restorative proctocolectomy and deciding on a single or a staged procedure remains the crucial issue of this surgery, since the majority of complications, including mortality, could be a consequence of this initial decision. To date, only 5 studies have focused on the comparison between the 2 and 3-stage approach: one from the same inventor of the pouch (RJ Nicholls) 18 , 3 with the series dating back to the 1980's [18][19][20] , one with a laparoscopic approach in 17.4% of the cases (25 patients) 78 , and only a recent one using the total laparoscopic approach in a consistent number of patients 65 . Hicks et al concluded in favour of the predominant use of 2-staged surgery, but the patients who underwent the 3-stage procedure in the study only totalled 28, and only 7 were treated by laparoscopy 78 .…”