title: 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: BACKGROUND
  There are very few studies and no consensus concerning the choice between two- and three-stage ileal pouch-anal anastomosis [IPAA] in inflammatory bowel diseases [IBD]. This study aimed to compare operative results between both surgical procedures.
  
  
  METHODS
  Only patients who underwent a laparoscopic IPAA for IBD were included. They were divided into two groups: two-stage [IPAA and stoma closure] [Group A] and three-stage IPAA [subtotal colectomy, IPAA, stoma closure] [Group B].
  
  
  RESULTS
  From 2000 to 2015, 185 patients (107 men, median age of 42 [range, 15-78] years) were divided into Groups A [n = 82] and B [n = 103]. Patients in Group B were younger than in Group A (39 [15-78] vs 43 [16-74] years; p = 0.019), presented more frequently with Crohn's disease [16% vs 5%; p < 0.04], and were more frequently operated in emergency for acute colitis [37% vs 1%; p < 0.0001]. Cumulative operative time and length of stay were significantly longer in Group B (580 [300-900] min, and 19 [13-60] days) than in Group A (290 [145-490] min and 10 [7-47] days; p < 0.0001). Cumulative postoperative morbidity, delay for stoma closure, and function were similar between the two groups. Long-term morbidity was similar between Group A [13%] and Group B [21%; p = 0.18].
  
  
  CONCLUSIONS
  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].
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France.
authors.forename: D
authors.initials: D
authors.lastname: Mège
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France Postgraduate Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: M N
authors.initials: MN
authors.lastname: Figueiredo
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France.
authors.forename: G
authors.initials: G
authors.lastname: Manceau
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France.
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.affiliation: Department of Gastroenterology, Beaujon Hospital, Université Paris VII, Clichy, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Université Paris VII, Clichy, France yves.panis@bjn.aphp.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ileal pouch-anal anastomosis; inflammatory bowel diseases