מתוך medicontext.co.il
NEW YORK (Reuters Health) – One-stage proctocolectomy with ileal pouch-anal anastomosis (IPAA) is associated with better operative outcomes than a two-stage procedure in ulcerative colitis patients who are candidates for either, according to a recent report by German investigators.
Previous study findings have suggested that a two-stage procedure, which includes a diverting ileostomy, is safer. However, many of these studies were flawed by their retrospective design of by the inhomogeneity of the subject's disease, pouch design, or the technique for IPAA.
To overcome these problems, Dr. Udo Heuschen and colleagues, from the University of Heidelberg, performed a matched-paired analysis of the two procedures that included only ulcerative colitis patients. Furthermore, a J pouch was constructed in all patients and the IPAA technique was standardized.
The study included 57 patients who underwent the one-stage procedure and 114 who underwent a two-stage operation, the investigators note in the December issue of the Annals of Surgery.
Patients who underwent the one-stage procedure were significantly less likely to experience early and late postoperative complications than patients who underwent the two-stage procedure. In addition, anastomotic strictures were less likely with the one-stage operation (p = 0.022).
The one-stage procedure is clearly superior to the two-stage operation in UC patients suitable for either. "This finding is of great clinical relevance both for the subjective interests of the patient and from an economic point of view," the investigators conclude.
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