Ileal pouch-anal anastomosis; 18 years of experience and outcomes across two generations of surgeons at a tertiary center in Sweden

Abstract

Aim

Reconstructive surgery with ileal pouch-anal anastomosis (IPAA) is the standard procedure after colectomy in patients with Ulcerative Colitis (UC) and Familial Adenomatous Polyposis (FAP). It is of interest to understand how a generation shift of the surgeons performing IPAA has affected patients’ outcomes.

Method

All consecutive patients who underwent IPAA in the period 1999–2016 at Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, were included. Surgeons representing two different generations performed the surgeries during this period. The following 6-year time periods were assigned for surgeries performed by: experienced surgeons (1999–2004; Period 1); the new generation of surgeons undergoing training (2005–2010; Period 2); and the new generation of experienced surgeons (2011–2016; Period 3). The primary endpoint was post-operative complications (Clavien-Dindo ≥3b), and the secondary endpoints were the functional outcome, failure of the pouch, and mortality. Logistic analyses of the results were performed.

Results

Overall, 281 patients were included in the study. The rate of post-operative severe complications was lower in Period 1 [Odds Ratio (OR) 0.137; p = .01]. There was no difference in functional outcome between the groups.

Conclusion

This study implicates that the risk of post-operative complications after IPAA is lower when the surgery is performed by a generation of more-experienced surgeons. This might support literature that concludes that surgical units that have a high throughput of patients and are staffed by surgeons who perform many procedures provide better outcomes.

Keywords:

• Ileal pouch-anal anastomosis
• IPAA
• learning curve
• colorectal surgery
• post-operative complications
• surgical volume

Disclosure statement

The authors declare no conflict of interest.

Ethical approval

The study was approved by Swedish Ethical Review Authority (Dnr. 2021-00380).

Additional information

Funding

This work was supported by ALF-Västra Götalandsregionen.