Related Experiment Video
Updated: Jan 14, 2026
Author Spotlight: Developing a Rat Model for Pouchitis Research and Treatment
Published on: May 31, 2024
Outcomes of Pouch Creation in 2-Stage Versus 3-Stage Procedures for Pediatric Ulcerative Colitis: A Propensity Score
Humza Thobani1, Anam N Ehsan1, Anoosha Moturu1
1Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States.
Insights
Comparing 2-stage and 3-stage ileal pouch-anal anastomosis (IPAA) for pediatric ulcerative colitis (UC), this study found similar major complication rates. These findings support the 2-stage approach for select pediatric UC patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Staged proctocolectomy with ileal pouch-anal anastomosis (IPAA) is standard for refractory pediatric ulcerative colitis (UC).
- Limited comparative data exists for 2-stage versus 3-stage IPAA in children.
- This study addresses surgical outcomes in pediatric UC patients undergoing different staged IPAA approaches.
Purpose of the Study:
- To compare surgical outcomes of 2-stage and 3-stage IPAA in pediatric UC patients.
- To evaluate major complication rates within 30 days post-IPAA.
- To assess the safety and efficacy of the 2-stage IPAA approach in children.
Main Methods:
- Retrospective analysis of the NSQIP-Pediatric database (2016-2023).
- Inclusion of pediatric patients (<18 years) with UC undergoing IPAA.
- 1:1 propensity score matching to compare 2-stage (IPAA with concurrent colectomy) and 3-stage (IPAA after prior colectomy) procedures based on disease severity.
Main Results:
- 479 patients included; 330 underwent 3-stage and 149 underwent 2-stage IPAA.
- The 2-stage group showed higher rates of steroid use, leukocytosis, and hypoalbuminemia at pouch creation.
- After propensity score matching (137 pairs), no significant difference in major complication rates was observed between the 2-stage and 3-stage groups.
Conclusions:
- Surgical outcomes following pouch creation were comparable between 2-stage and 3-stage IPAA in a matched pediatric UC cohort.
- The findings support the consideration of a 2-stage IPAA approach for specific pediatric UC patients.
- This research contributes to optimizing surgical strategies for pediatric ulcerative colitis management.
Background:
Staged proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for medically refractory pediatric ulcerative colitis (UC). This study aimed to compare the surgical outcomes of 2-stage and 3-stage IPAA in children of similar disease severity.
Methods:
We queried the NSQIP-Pediatric database (2016-2023) to identify patients under 18 years with UC undergoing IPAA. Patients undergoing IPAA with concurrent colectomy were classified as having a 2-stage procedure, while those undergoing IPAA alone, following a prior colectomy, were classified as having a 3-stage procedure. The primary outcome was a composite of major complications within 30 days, including mortality, organ/space infection, progressive renal insufficiency, systemic sepsis, and intra-abdominal reoperation. The treatment groups were matched using 1:1 propensity score matching to adjust for baseline differences in disease severity.
Results:
A total of 479 patients met the inclusion criteria (330 underwent 3-stage and 149 underwent 2-stage procedures). The proportion of patients undergoing each approach remained stable over the study period (P = .693). At the time of pouch creation, the 2-stage group had significantly higher rates of steroid use (22.8% vs 14.5%), leukocytosis (21.9% vs 7.1%), and hypoalbuminemia (mean 4.0 vs 4.2 g/dL). After matching, 137 patient pairs were included. There was no significant difference in major complication rates between groups (OR, 1.38; 95% CI, 0.63-3.09).
Conclusions:
This study demonstrated that surgical outcomes following pouch creation were similar in a matched cohort of children undergoing 2- or 3-stage IPAA, supporting the use of a 2-stage approach in certain patients with limited disease.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:24Ostomy Care
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies: