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Original research
Development of a specialist ileoanal pouch surgery pathway: a multidisciplinary patient-centred approach
  1. Valerio Celentano1,2,
  2. Henna Rafique1,2,
  3. Melanie Jerome1,
  4. Yu Jin Lee1,
  5. Christos Kontovounisious1,2,
  6. Oliver Warren1,2,
  7. Alexander MacDonald1,2,
  8. Mahmood Wahed1,2,
  9. Sarah Mills1,2,
  10. Paris Tekkis1,2
  1. 1Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2Department of Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to Mr Valerio Celentano, Chelsea and Westminster Hospital NHS Foundation Trust, London, SW10 9NH, UK; valeriocelentano{at}yahoo.it

Abstract

Background Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the gold standard procedure for ulcerative colitis refractory to medical treatment, as an alternative to permanent end ileostomy. Gaining experience in pouch surgery is difficult as the procedure is performed infrequently. This study presents an institutional initiative to promote standardisation of multidisciplinary care in IPAA surgery.

Methods A dedicated pathway for patients who had an IPAA or are considering IPAA surgery was developed among colorectal surgeons, gastroenterologists, paediatric colorectal surgeons, inflammatory bowel disease (IBD) nurses, dietitians, stoma nurses, trainees in colorectal surgery. Pathway items were discussed and finalised via emails and videoconferences.

The pathway included triaging of patients referred for IPAA surgery, preoperative IBD multidisciplinary team discussion and management plan for surgery, surgical review prior to surgery, peer to peer counselling, surgical technique, postoperative short-term and long-term follow-up, audit, research and training in IPAA surgery.

Results A multidisciplinary preoperative pathway was developed and a stepwise approach to minimally invasive ileoanal pouch surgery was formalised. A dedicated one-stop ileoanal pouch clinic was established integrating endoscopy and imaging on the same day of the consultation with the surgical and gastroenterology team. The clinic reviewed 72 patients over 24 months, and during the same time 36 patients underwent IPAA surgery at our institution.

Conclusions We have described our initial experience in establishing a specialist IPAA surgery pathway and have proposed outcome measures that we hope will support a subspecialty IPAA service.

  • ILEOANAL POUCH

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Contributors VC, study design, data collection, draft manuscript, study guarantor. HR, study design, data collection, draft manuscript. MJ data collection, data analysis. YJL, data collection, draft manuscript. CK data analysis, manuscript review. OW, study design, manuscript draft. AM data collection, data analysis, manuscript draft. MW study design, manuscript review. SM study design, data analysis, manuscript review. PT, study design, data analysis, manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Preliminary data from this study have been presented at the British Society of Gastroenterology 2022 conference in Birmingham, UK.