Editorial: Regionalisation of ileoanal pouch surgery

Deputy, Mohammed; Celentano, Valerio; Faiz, Omar

doi:10.1111/codi.16112

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…International recognition of the high proportion of LV pouch hospitals, along with the development of IBD quality of care guidelines, has led to recommendations for greater scrutiny of patient outcomes overseas 10,31,32 . This has led to a debate about the delivery of pouch surgery at a national structural level in countries including the UK, with suggestions that centralizing IBD pouch surgery to fewer trusts, thereby facilitating greater institutional volume may result in improved patient outcomes 4,16,33 . Numerous studies have identified a clear volume outcome relationship for multiple pouch related outcomes 5–7,14,15,22,30,34–38 …”

Section: Discussionmentioning

confidence: 99%

“…10,31,32 This has led to a debate about the delivery of pouch surgery at a national structural level in countries including the UK, with suggestions that centralizing IBD pouch surgery to fewer trusts, thereby facilitating greater institutional volume may result in improved patient outcomes. 4,16,33 Numerous studies have identified a clear volume outcome relationship for multiple pouch related outcomes. [5][6][7]14,15,22,30,[34][35][36][37][38] It would seem though, that the volume-outcome relationship for pouch surgery is complex.…”

Section: Discussionmentioning

confidence: 99%

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Population outcomes, trends and the future of pouch surgery for ulcerative colitis: a 19‐year New South Wales data linkage study

Giddings

Solomon

et al. 2023

ANZ Journal of Surgery

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BackgroundIleal pouch‐anal anastomosis (IPAA) is considered the gold standard reconstructive option in ulcerative colitis (UC). Recent efforts to improve pouch outcomes have seen a push towards centralisation of surgery. This study aimed to document outcomes following pouch surgery at a population level within New South Wales (NSW), and identify factors associated with, and temporal trends of these outcomes.MethodsA retrospective data linkage study of the NSW population over a 19‐year period was performed. The primary outcome was pouch failure in patients with UC who underwent IPAA. The influence of hospital level factors (including annual volume) and patient demographic variables on this outcome were assessed using Cox proportional hazards modelling. Temporal trends in annual volume and evidence for centralisation over the studied period were assessed using Poisson regression analysis.ResultsThe annual volume of UC pouches reduced over the study period. The pouch failure rates were 8.6% (95% CI 6.3–10.8%) and 10.6% (95% CI 8.0–13.1%) at 5‐ and 10‐years, respectively. Increasing age and non‐elective admission were associated with higher failure rates. One‐third of UC pouches (31.6%) were performed in a single institution, which averaged 6.5 pouches/year throughout the study period. Three‐quarters (19/25) of NSW public hospitals who performed pouches performed less than one UC pouch annually.ConclusionsThe outcomes following UC pouch surgery in NSW are comparable with global standards. Concentrating IBD pouch surgery with the aim of producing specialist surgical teams may be a reasonable way forward in NSW and would ensure equity of access and facilitate research and training collaboration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Population outcomes, trends and the future of pouch surgery for ulcerative colitis: a 19‐year New South Wales data linkage study

Giddings

Solomon

et al. 2023

ANZ Journal of Surgery

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“…Indication for excisional and revisional surgery was discussed at the dedicated IBD MDT, and more recently, also to a multi-hospitals pouch MDT, co-chaired by the corresponding author of this study [5].…”

Section: Methodsmentioning

confidence: 99%

Ileoanal pouch revision and excision surgery in a newly established pouch center. Requirements and costs for service provision

Celentano¹,

Lee²,

Rebelo³

et al. 2023

Preprint

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Background: Complications of ileoanal pouch surgery affecting function and quality of life may require surgical correction or pouch excision. The management of patients with pouch dysfunction requires a multidisciplinary approach and demand for service provisions include multiple healthcare professionals and resources. The aim of this study is to present the service requirements, surgical outcomes for redo pouch surgery and pouch excision, with cost-analysis of the required resources. Methods: All patients undergoing surgery for revision or excision of the ileoanal pouch from June 2021 to May 2023 were prospectively included. Patient undergoing only diagnostic procedures, or perineal procedures were excluded. Outcomes within 30-days of surgery were collected, including readmissions and re-operations. Cost analysis of all investigations, outpatient appointments and procedures prior to pouch revision or pouch excision was conducted. Results: Twenty patients were included during the 24 months study period: 13 underwent abdominal revisional pouch surgery, 7 had ileoanal pouch excision. 15 patients (75%) were tertiary referrals from other hospitals in the UK. The median interval between index IPAA surgery and revision was 113 months. 3 multidisciplinary clinical appointments, 2 imaging modalities, and at least one invasive day-surgery procedure were required for each patient prior to surgery. Four patients (20%) developed Clavien-Dindo 3 or higher complications. Conclusions: We estimated a starting cost of £22.605 ($29.589) for provision of pouch revision or excision surgery for investigations and treatments from referral to the pouch unit to surgery. Expertise and infrastructure are needed for indication and peri-operative management of these uncommonly performed surgical procedures.

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“…Dear Editor, Patient centralisation in inflammatory bowel disease is proven to provide better outcomes due to the technical challenges faced when dealing with a complex case of Crohn's or colitis [1,2]. Multiple technical and clinical step failures in nonreferral IBD centres can lead to severe dysfunction and the need for more complex procedures at the expense of the patient's quality of life [3].…”

Section: Ileoanal Pouch Excision: How Multiple Technical Failures Can...mentioning

confidence: 99%

Ileoanal pouch excision: How multiple technical failures can lead to pouch dysfunction—a video vignette

Manzo,

Celentano

2024

Colorectal Disease

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We describe herein robotic complete splenic flexure mobilization using a standardized step by step approach.Splenic flexure mobilization is one of the essential steps in colorectal surgery to achieve a safe tension-free well-perfused anastomosis. Robotic complete splenic flexure mobilization can be technically demanding either due to external arm collisions or to the limited range of motion of the arms. Unique to this technique are: (1) single docking, (2) a standardized inferior mesenteric vein (IMV)-first sub-mesocolic approach and (3) lesser

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Editorial: Regionalisation of ileoanal pouch surgery

Cited by 6 publications

References 7 publications

Population outcomes, trends and the future of pouch surgery for ulcerative colitis: a 19‐year New South Wales data linkage study

Population outcomes, trends and the future of pouch surgery for ulcerative colitis: a 19‐year New South Wales data linkage study

Ileoanal pouch revision and excision surgery in a newly established pouch center. Requirements and costs for service provision

Ileoanal pouch excision: How multiple technical failures can lead to pouch dysfunction—a video vignette

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