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Pediatric ulcerative colitis: three- versus two-stage colectomy with ileal pouch-anal anastomosis

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Abstract

Background

Despite advancements in medical therapy for ulcerative colitis (UC), a significant proportion of children progress to colectomy with ileal pouch-anal anastomosis (IPAA). Procedural related complications between two- and three-stage operations in children have not been well described.

Methods

We performed a retrospective review of patients who underwent a colectomy for UC or inflammatory bowel disease unclassified between 2008 and 2018.

Results

Forty-nine children underwent an IPAA at the time of colectomy (two stage) or during a subsequent operation (three stage). Preoperative hemoglobin and albumin concentrations were lower among those undergoing three-stage procedures. The rate of early complications (≤30 days) was similar between the two groups (p = 0.46); however, late complications (>30 days) were more commonly associated with three-stage procedures (p = 0.03). Time with a stoma was 3.2 months longer among those who underwent a three-stage procedure. While three-stage procedures were more often performed during the first half of the study period (2008–2012), two-stage procedures became more common during the second half (2013–2018). During this transition to favor two-stage procedures, complication rates did not significantly change.

Conclusion

Although three-stage procedures were thought to be associated with fewer complications, we found comparable complication rates as we transition to two-stage procedures.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, Box 323, Aurora, CO, 80045, USA

    S. Christopher Derderian, Ryan Phillips, Shannon N. Acker, Jennifer Bruny & David A. Partrick

Authors
  1. S. Christopher Derderian
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  2. Ryan Phillips
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  3. Shannon N. Acker
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  4. Jennifer Bruny
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  5. David A. Partrick
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Correspondence to David A. Partrick.

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Derderian, S.C., Phillips, R., Acker, S.N. et al. Pediatric ulcerative colitis: three- versus two-stage colectomy with ileal pouch-anal anastomosis. Pediatr Surg Int 36, 171–177 (2020). https://doi.org/10.1007/s00383-019-04595-x

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  • DOI: https://doi.org/10.1007/s00383-019-04595-x

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