title: Ileo-anal pouch surgery in a district general hospital results in good outcomes and high patient satisfaction.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Colorectal Surgery, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, United Kingdom. Electronic address: klynes@nhs.net.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lynes
authors.affiliation: Department of Colorectal Surgery, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, United Kingdom.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lawes
authors.affiliation: Department of Colorectal Surgery, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, United Kingdom.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Bailey
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D057868:Anastomotic Leak / Q000209:etiology; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D003672:Defecation; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D066231:Surgeons; D054047:Surgical Stomas; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Inflammatory bowel disease; Pouch surgery; Restorative proctocolectomy; Ulcerative colitis