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

  • S. Christopher Derderian
  • Ryan Phillips
  • Shannon N. Acker
  • Jennifer Bruny
  • David A. PartrickEmail author
Original Article



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.


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


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.


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


Ulcerative colitis Indeterminant colitis Inflammatory bowel disease unclassified Ileal pouch-anal anastomosis Two-stage procedure Three-stage procedure Complications 


Compliance with ethical standards

Conflict of interest

No authors have a conflict of interest to disclose.

Supplementary material

383_2019_4595_MOESM1_ESM.docx (13 kb)
Supplementary file1 (DOCX 13 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • S. Christopher Derderian
    • 1
  • Ryan Phillips
    • 1
  • Shannon N. Acker
    • 1
  • Jennifer Bruny
    • 1
  • David A. Partrick
    • 1
    Email author
  1. 1.Department of Pediatric Surgery, Children’s Hospital ColoradoUniversity of Colorado School of MedicineAuroraUSA

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