Friday, July 22, 2011

Two Stage vs Three Stage Colectomy

I was researching the differences between a two stage and three stage colectomy and came up with this interesting abstract from:

Dis Colon Rectum. 1989 Apr;32(4):323-6.
Restorative proctocolectomy with ileal reservoir. Comparison of two-stage vs. three-stage procedures and analysis of factors that might affect outcome.
Nicholls RJ, Holt SD, Lubowski DZ.
St. Mark's Hospital, London, United Kingdom.

Restorative proctocolectomy and ileal reservoir, performed as a two-stage procedure, has the advantages of a shorter hospital stay, one less anesthetic, and a shorter time with a stoma when compared with the three-stage procedure. In a prospective, nonrandomized study of 152 consecutive patients undergoing restorative proctocolectomy (57 two-stage and 95 three-stage), the complication rates for the ileal reservoir phase and the functional results of the two- and three-stage operations were compared. The results suggest that there is no advantage to the three-stage procedure except in the following circumstances: when urgent surgery is required for the complications of ulcerative colitis, when malignancy or Crohn's disease cannot be ruled out, and when a patient with active colitis has a combination of a low hemoglobin value (male less than 13.5 g/dl, female less than 11.5 g/dl), a low serum albumin level (less than 40 g/l), and is taking oral steroids.

What that means in laymen's terms is that there is no significant difference in the two. That is unless you may have a possible tumor, Crohn's, are anemic or are on steroids such as Prednisone. Since I fall in the last of those categories then I suspect that that's one of the reasons why I will be having a three stage surgery as opposed to a two stage. I'll see you all on Monday and then Wednesday it's party time.

Some may wonder "what is a two/three stage" and so forth well a two stage surgery involves:
Stage one: Removal of colon, installation of stoma and colostomy bag, forming of "j" in small intestine.
Stage two: Removal of colostomy and connection of j-pouch to anus.

The three stage involves:

Stage one: Removal of colon, installation of stoma and colostomy bag.
Stage two: Forming of "j" in small intestine. Removal of rectum.
Stage three: Removal of colostomy and connection of j-pouch to anus.

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