Trends in the Utilization of Two-Stage Versus Three-Stage Ileal Pouch Anal Anastomosis Among Privately…

Cohort studyDiseases of the colon and rectum· Aug 2026

Trends in the Utilization of Two-Stage Versus Three-Stage Ileal Pouch Anal Anastomosis Among Privately Insured Patients With Ulcerative Colitis in the USA, 2007 to 2023.

Kathryn K Taylor, Cindy J Kin, Natalie N Kirilcuk … Aaron J Dawes

Colon & Rectal SurgeryCohort studyClinical practiceQ2IF 1.6

Traditional 2-stage pouch surgery use fell steadily as 3-stage and modified 2-stage rose.

Trends in the Utilization of Two-Stage Versus Three-Stage Ileal Pouch Anal Anastomosis Among Privately Insured Patients With Ulcerative Colitis in the USA, 2007 to 2023.

Kathryn K Taylor … Aaron J Dawes

Diseases of the colon and rectum · Aug 2026 · Q2 in Gastroenterology

Background

Ileal pouch anal anastomosis can be performed via 2- and 3-stage techniques, with similar short- and long-term clinical outcomes.

Purpose

To compare trends in the utilization of 3-stage, traditional 2-stage, and modified 2-stage IPAA for ulcerative colitis as well as markers of disease severity over time.

Methods

Non-elderly adults with a diagnosis of ulcerative colitis who underwent ileal pouch anal anastomosis between 2007 and 2023 and remained enrolled in their insurance plan for ≥ 6 months after surgery.

Results

traditional 2-stage surgery use declined steadily as newer approaches took over

% points/year -1.30 (95% CI -1.70 to -0.90)

CI excludes the null - significant

More results

Four thousand thirty-nine patients underwent IPAA during the study period (2,179 traditional 2-stage; 1,107 3-stage; and 753 modified 2-stage).

Patients undergoing 3-stage or modified 2-stage IPAA had a more rapid increase in exposure to advanced therapies in the year before surgery (+ 2.9 vs + 2.0% points).

More results

Limitations: potential misclassification, generalizability.

“

Conclusion · 1 of 2

More patients are undergoing 3-stage and modified 2-stage operations than traditional 2-stage ileal pouch anal anastomosis.

Conclusion · 2 of 2

This shift parallels an increase in multiple markers of disease severity at IPAA creation, especially exposure to advanced therapies. See Video Abstract.

Trends in the Utilization of Two-Stage Versus Three-Stage Ileal Pouch Anal Anastomosis Among Privately Insured Patients With Ulcerative Colitis in the USA, 2007 to 2023.

Trends in the Utilization of Two-Stage Versus Three-Stage Ileal Pouch Anal Anastomosis Among Privately Insured Patients With Ulcerative Colitis in the USA, 2007 to 2023.

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