Browsing by Author "Perry-Woodford, Z."
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Item Improving quality of life after pouch surgery with a dedicated nurse led follow up programme(Wiely-Blackwell, 2016) Chandrasinghe, P.; Leo, A.; Alison, L.; Perry-Woodford, Z.; Warusavitarne, J.AIM:Bowel function after ileal pouch affects the quality of life (QOL). The aim of the study was to assess if objective evaluation and specialised supportive care improves QOL after pouch surgery.METHOD: Consecutive patients who had an ileoanal pouch were invited to participate in a systematic follow-up regime led by specialised pouch nurse practitioners. The Cleveland global Quality of Life (CGQOL) and specific pouch related symptoms were documented at 6, 12, 24 and 52 weeks after ileostomy reversal. Pearson's Rho coefficient was used to assess the correlation between symptoms and CGQOL. RESULTS: Thirty-nine consecutive patients who had ileoanal pouch surgery were evaluated. Thirty-four had more than two visits and improvement in CGQOL (mean-1.36 ± 0.95) was seen in 27 (79%). There was reduction in CGQOL in 5 patients (15%) and no change in 2 (6%). Daytime frequency (DTF) significantly correlated with mean CGQOL (R = −0.7, P < 0.01). Twenty (59%) of 34 had reduced DTF after intervention. Nocturnal frequency only showed correlation with CGQOL up to 3 months. Incontinence had no impact on the QOL in this cohort. CONCLUSION: DTF has the highest impact on QOL in this cohort. Regular systematic specialised pouch care follow up may achieve better QOL.Item Transanal ileal pouch-anal anastomosis for ulcerative colitis has comparable long-term functional outcomes to transabdominal approach: a multicentre comparative study(Elsevier Science., 2020) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Foppa, C.; Tanis, P.; Perry-Woodford, Z.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.BACKGROUND:The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis (UC). The aim of this study was to assess the long-term functional outcomes after Ta-IPAA versus transabdominal IPAA (Abd-IPAA) in UC.STUDY DESIGN:A multicentre cohort analysis was done between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL (Cleveland global quality of life) score at 12 months with a functioning pouch was considered the primary endpoint.RESULTS:A total of 374 patients (100 Ta-IPAA vs 274 Abd-IPAA) were included. Ta-IPAA demonstrated a comparable overall quality of life (CGQL score) to Abd-IPAA (0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p=0.1). Quality of life (7.71 ± 1.17 vs 7.30 ± 1.46; p=0.04) and energy level items (7.16 ± 1.52 vs 6.66 ± 1.68; p=0.03) were significantly better after Ta-IPAA, while the quality of health item was comparable (7.68 ± 1.26 vs 7.64 ± 1.44; p=0.96). Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies (>10/ 24 hrs:22% vs 21%; p=1.0) and the rate of single episode of major incontinence during the 12-month period (27% vs 26%; p=0.89) were similar. The differences in thirty-day morbidity rates (33% vs 41%; p=0.2) and the anastomotic leak rates were not significant (6% vs 13%; p=0.09). CONCLUSION AND RELEVANCE:This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.