P584 Complication rates after two-stage vs three-stage restorative proctocolectomy with ileoanal pouch construction in the era of biologics

Abstract

Abstract Background Patients with proctocolectomy and ileoanal pouch construction typically undergo a two-stage or three-stage surgical procedure, depending on the general condition and recent immunosuppressive therapy. Our single center database prospectively records all surgeries performed since 2021 and retrospectively of patients before this year. Complications are registered by Clavien-Dindo classification. Methods All patients with two-stage or three-stage proctocolectomy and ileoanal pouch construction were identified from the database. The prevalence and severity of complications was analyzed according to Clavien-Dindo, with scores of 3 and above classified as severe complication. Patients were grouped by having either one or more severe complications or none at any surgical procedure. Results 102 patients were identified from the database, of those 44 (43%) had a two-stage procedure and 58 (57%) a three-stage procedure. In the three-stage group, 25 (43%) patients were on active systemic corticosteroid therapy at the time of the first surgery compared to 0 patients in the two-stage group (p<0.001). Biological therapy within the last 3 months before the first surgery was received by 35 (60%) of the patients in the three-stage group versus 16 (36%, p=0.016 ) in the two-stage group. The three-stage procedure resulted in 11 out or 58 patients (19%) having at least one major complication compared to 3 out of 44 patients (7%) of the group with two-stage approach (p=0.077). Conclusion There is a trend towards a higher major complication rate in patients operated by a three- versus a two-stage approach in restorative proctocolectomy. This may be due to a selection bias as patients undergoing a three-stage procedure had significantly more often steroids at the time of first surgery and significantly more often biological therapy three months before the first surgery. Further data collection and then multivariate analysis including further risk factors, need to be done in order to better define the preferable individual surgical strategy.