News

A surgeon at Kettering General Hospital has carried out a new operation which marks the launch of a new county pouch service for some suitable complex inflammatory bowel disease patients.

The procedure is called an ileoanal pouch formation and involves enabling the ileum (the lower end of the small intestine), to be joined to the anus following removal of the larger bowel (colon) and rectum. 

This creates an internal pouch for the patient to replace partially the function of the rectum, store stools which is passed through a normal defecation process.

It was performed for the first time at Kettering General Hospital just before Christmas and a team has now been formed to support Northants patients who have the procedure.

So far suitable patients have had to travel to different pouch centres around the country for consultation about a pouch formation, or about complications related to the pouch, but now this specialty service is being delivered at KGH.

The pouch service team is composed of Consultant Colorectal and IBD Surgeon, Mr Triantafyllos Doulias, Inflammatory Bowel Disease lead, and Consultant Gastroenterologist, Dr Farhad Peerally, Stoma and Pouch Nurse Specialist, Helen Drage, and Dietitian, Jon Lawrence, and is also supported by the Inflammatory Bowel Disease team.

The team will initially support a relatively small number of patients who can choose to have this procedure co-ordinating with experts at the Chelsea and Westminster Hospital where Mr Doulias collaborates and has performed more than 20 pouch/complex inflammatory bowel disease procedures in the last three years

Mr Doulias said: “This type of surgery is for some patients who have had their colon and rectum surgically removed due to mainly Ulcerative Colitis disease but also sometimes for well selected patients with Crohn’s disease, familial adenomatous polyposis(a rare inherited condition) or cancer.

“It is not suitable for everyone with those problems but for some patients, who would otherwise have had a permanent ileostomy (stoma).

“The pouch will allow these patients to pass stools in a normal way without the need for an external bag.

“In most cases the treatment is successful and it can improve their quality of life by enabling them to function more normally.”

Mr Doulias said the surgery itself is the ‘easy part’ of establishing a service.

He said: “This is about far more than just doing the surgery. There needs to be intensive individualised nursing support for the patient, you also need networks of support and specialist advice in case of complications.

“That is why I have being working with leading experts at Chelsea and Westminster who are linking in with us and supporting our new service. Every patient we agree to offer a pouch to will be reviewed by both our team and the one at Chelsea and Westminster.

“Like all procedures though it comes with risks as well as benefits and having one involves patients weighing these up carefully with the support of specialist medical professionals.”

Stoma Care Nurse Helen Drage will be UHN’s first Pouch Nurse Specialist after receiving training at Chelsea and Westminster.

She said: “After the procedure I will be in regular contact to support patients with their follow-up care, with access to surgical and inflammatory bowel disease services.

“At first patients who have had the procedure will have a stoma bag until their pouch and surrounding tissue heals after surgery.

“We will support them intensively for the first year until they develop more normal function but they will always have access to the service via phone or email as long term, ongoing support if it is needed.”

It is hoped the team will be able to support more than 15 patients per year to have a pouch procedure with potentially more in the future. As the service expands the team will be supported by a dedicated psychiatrist and surgical post specialty training programme doctors with an interest in pouch surgery.