B Kochar et al. Inflamm Bowel Dis 2018; 24: 1833-9. This study reviewed prospectively collected data from 2011-2015 involving 2390 Ileal Pouch Anal Anastomosis (IPAA) surgeries for ulcerative colitis in those ≥18 years of age. Two approaches were compared:
- ‘Traditional’ 2- stage IPAA where the pouch is created with the colectomy
- Or a 3-stage surgery where the pouch is created in a second surgery after the colectomy (delayed pouch creation)
Key findings:
- Delayed pouch creation were significantly less likely to have an unplanned reoperation (RR =0.42, CI 0.24-0.75) and less likely to have major adverse events (RR=0.72, CI 0.52-0.99)
- Those in the delayed pouch creation group were much less likely to be receiving chronic immunosuppression at the time of surgery –15% compared to 51% in 2-stage group
My take: Particularly for sicker patients, delayed pouch creation (3-stage procedure) is likely to be best approach.
Related blog posts:
- CCFA: Updates in IBD 2017
- IPAA for Crohn’s and Indeterminate Colitis
- Crohn’s disease diagnosis identified after colectomy
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