title: Minimally invasive pouch surgery for ulcerative colitis: is there a benefit in staging?
abstract: BACKGROUND
  With the introduction of biologic agents, medical and surgical management of ulcerative colitis has been associated with significant morbidity. A staged surgical approach is advocated to obviate the risks of infectious complication and consequent poor pouch function.
  
  
  OBJECTIVE
  The aim of this study was to analyze the outcomes of our selective staged approaches in patients with ulcerative colitis who were undergoing laparoscopic pouch surgery.
  
  
  METHODS
  Consecutive patients with ulcerative colitis referred for laparoscopic surgical treatment between 2002 and 2008 were included in the study. Data were prospectively collected. Patients were divided into 2 groups: a 3-stage group, initial laparoscopic abdominal colectomy followed by pouch surgery with a diverting loop ileostomy, and a 2-stage group, laparoscopic pouch surgery with a diverting loop ileostomy at the initial operation.
  
  
  RESULTS
  Of the 118 patients eligible for the study, 68 were in the 2-stage group and 50 were in the 3-stage group. Patients were more likely to have been receiving aggressive medical therapy in the 3-stage group than in the 2-stage group: 43% vs 16% (P = .01) receiving anti-tumor necrosis factor therapy and 96% vs 67% (P = .04) receiving systemic corticosteroids. Although overall complication rates were similar between groups (P = .4), infectious complications were higher in the 2-stage group (38.2% vs 21%, P < .05).
  
  
  CONCLUSIONS
  In our practice, we have selectively applied a 3-stage laparoscopic surgical approach to restorative proctocolectomy in patients with ulcerative colitis who are receiving aggressive medical therapy in an attempt to minimize perioperative complications. This strategy appears efficacious, and short-term outcomes compare favorably with those following a 2-stage approach.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Sushil
authors.initials: S
authors.lastname: Pandey
authors.forename: Gaurav
authors.initials: G
authors.lastname: Luther
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.forename: Gautham
authors.initials: G
authors.lastname: Malhotra
authors.forename: Michele A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Roger D
authors.initials: RD
authors.lastname: Hurst
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult