Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions

doi:10.4292/wjgpt.v17.i2.118778

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 118778
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.118778

Table 4 Two-stage vs three-stage ileal pouch-anal anastomosis

Feature	Two-stage IPAA	Three-stage IPAA
Typical sequence	Proctocolectomy + IPAA + diverting ileostomy → ileostomy closure	Subtotal colectomy + end ileostomy → completion proctectomy + IPAA + DI → closure
Usual candidates	Medically optimized, lower-risk, stable patients	Acute severe colitis, high-dose steroids, biologic rescue, malnutrition
Short-term morbidity	Comparable to 3-stage in modern series	Comparable; offers safer route in very sick patients
Pouch failure/leak	No significant difference vs 3-stage	No significant difference vs 2-stage
Quality of life after closure	Similar global and functional PROs between strategies	Similar global and functional PROs

PRO: Patient-reported outcomes; IPAA: Ileal pouch-anal anastomosis; DI: Diverting ileostomy.

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Citation: Agrawal H, Gupta N. Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions. World J Gastrointest Pharmacol Ther 2026; 17(2): 118778
URL: https://www.wjgnet.com/2150-5349/full/v17/i2/118778.htm
DOI: https://dx.doi.org/10.4292/wjgpt.v17.i2.118778

Agrawal H, Gupta N. Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions. World J Gastrointest Pharmacol Ther 2026; 17(2): 118778 [PMID: 42273245 DOI: 10.4292/wjgpt.v17.i2.118778]

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