Ileo-anal pouch surgery in a district general hospital results in good outcomes and high patient satisfaction.

INTRODUCTION: Restorative proctocolectomy (RPC) with ileal-pouch anal anastomosis (IPAA) is a technically challenging procedure. This study aims to review the outcomes following surgery carried out in a DGH by two surgeons with experience gained in tertiary centres.

MATERIALS AND METHODS: All patients undergoing RPC with IPAA were identified from a prospectively collected database and case notes reviewed. Data were collected on demographics, indication for surgery, operative details, outcomes and adherence to a treatment and follow-up protocol developed with a specialist centre. A validated questionnaire (the Pouch Functional Score) was sent to patients to assess functional outcome.

RESULTS: Fourteen patients (nine male) underwent surgery from 2008 to 2012, average age 32 years (range 22-48). Median follow up was 5 years (interquartile range 3.2 years). The indication for surgery was ulcerative colitis. All patients had a 'J' shaped pouch, stapled anastomosis and defunctioning ileostomy. There was no operative mortality. One patient was re-admitted with high ileostomy output; three developed wound infections. All patients have had their stomas closed. There were no postoperative cases of pelvic sepsis or anastomotic leak. The median stool frequency is 6-8/24hrs, 23% of patients reported urgency, 23% had occasional incontinence. The protocol was adhered to in all cases. One patient required defunctioning of the pouch 5 years after surgery.

CONCLUSION: With good patient selection, a team approach and a protocol ensuring consistent care, pouch surgery is being performed to a high standard in a DGH setting. Follow-up care is provided locally and patients have easy access to the multidisciplinary team.