Can a new surgical technique improve quality of life after ileal pouch surgery?

What this research looked at

Ulcerative Colitis can be treated with surgery to remove the large bowel. People who have their large bowel removed may choose whether to have a permanent stoma or an ileal pouch. 

• Stoma: A stoma is created when the intestine is brought to the surface of the tummy (abdomen) and an opening is made to allow poo to drain into a bag, rather than through a person's bottom.  
• Ileal pouch: An ileal pouch is created by folding the end of the remaining small bowel onto itself to form a pouch that is joined to the anus. This allows poo to come out the normal way through the person's bottom. 

15% of people with an ileal pouch suffer from complications after the surgery and need further surgery to create a permanent stoma. The most common reason for this is ongoing inflammation around the pouch caused by infections. This is often the result of a leak in the join between the pouch and the anus. 

This study investigated if a new surgical technique results in less leakage and fewer infections, and therefore a better quality of life for people with Ulcerative Colitis. 

What the researchers found 

This researchers identified over 70 patients who underwent pouch surgery over the last four years. The results showed that the new surgical technique used to make the join during ileal pouch surgery caused leaks at a similar rate to the previous techniques. 

What the researchers think this could mean for people with Colitis 

The aim of pouch surgery is to improve the quality of life for people with Ulcerative Colitis. If the join in the pouch leaks, which may come months or years after surgery, the ongoing infections and the need for more operations, and eventually a permanent stoma, have very significant and negative impacts on quality of life. 

This study helps to highlight that leaks continue to cause problems, even for newer techniques. To investigate this further, the researchers are combining their data with results from other international centres. By doing this, they will be able to use a larger amount of data and see if a similar issue occurs in other countries in Europe.

As part of the study, the researchers also discovered that leaks may not be noticed straight away, as they may not cause symptoms. The researchers hope to design a new programme to help pick up these 'silent' leaks. 

Who lead this research: Professor Omar Faiz, St Mark’s Hospital and Academic Institute 
Our funding: £18,150 
Duration:  36 months 
Official title of application: CIRCILS – A comparison of anastomotic interventions in a prospective cohort of ileal pouch surgical patients.