Research Studies

Currently, the pelvic pouch procedure is usually performed laparoscopically with access via the abdomen. More recently, however, trans-anal access has been introduced for dissection of the rectum, further decreasing the invasiveness of surgery and potentially improving postoperative recovery. The safety of this approach in terms of surgical complications has been demonstrated in several studies and is performed routinely in some high volume centers.

The major advantage of transanal access is better exposure of the bottom part of the rectum through the anus. This area is quite difficult to see when the laparoscopic approach is used, since the bones of the pelvis are in the way and block the view of the entire rectum. The trans-anal approach has allowed more complete minimally invasive surgery to be performed, reducing the need to convert to open surgery because of difficult visualization of the rectum. Transanal IPAA surgery requires the introduction of a port through the anus to create access. This occurs during the surgery while the patient is asleep. Although several studies have demonstrated that this device can be introduced in the anus without functional harm to the anus, more robust data are required to validate this technique.

Therefore, this study aims to compare postoperative bowel function, sexual function and overall quality of life between patients operated by open or laparoscopic IPAA and transanal IPAA. We are also interested to identify whether the surgical approach has an impact on these outcomes.

Assessing pouch function in PSC patients

Primary sclerosing cholangitis (PSC) is an idiopathic disease, characterized by the inflammation and fibrosis of the biliary tree. PSC occurs in 5-8% of patients with ulcerative colitis (UC), and these patients who have concomitant diagnosis represent a distinct patient population requiring high level decision making regarding competing risks. Despite improving drugs and a better understanding of mechanisms, the risk of a colectomy for refractory colitis or UC related dysplasia in this cohort remains high. The current preferred restorative surgery of choice is an ileal pouch-anal anastomosis (IPAA) procedure. Despite the widespread use of this procedure, there is limited research on the long-term functional outcomes of ileoanal pouch function in patients with PSC and UC. There is some preliminary evidence that patients with PSC have worse pouch function compared to patients with UC alone.3 Several retrospective cohort studies have suggested that the rate of pouchitis and pouch failure is higher in patients with PSC and UC than in patients with UC alone. We are hoping this study will provide important insights into the functional outcomes of the ileoanal pouch in this cohort. The results of this study may help guide clinical decision-making and improve patient outcomes following IPAA surgery.

Patient Preference on Modes of Delivery

Our team is interested and have extensive experience in assessing patients’ preferences in treatment options. Please see below for previous papers published on the topic of patient preferences.

• Three-stage versus modified two-stage surgery for ulcerative colitis: a patient-centred treatment trade-off study
• Laparoscopic Versus Transanal IPAA for Ulcerative Colitis: A Patient-Centered Treatment Trade-Off Study

In this study, we aim to investigate patients’ preferences in the mode of delivery following ileal pouch-anal anastomosis (IPAA).

Women with ulcerative colitis (UC) or inflammatory bowel disease unclassified (IBDu) are often diagnosed in their reproductive years, interfering with family planning decisions, pregnancies and delivery. Proctocolectomy with IPAA is most performed, as it is associated with good quality of life and high patient satisfaction. However, the mode of delivery following IPAA is subject to ongoing debate and there is a lack of consistent evidence on its effect on the functional outcome of pouches. Despite this, many surgeons recommend patients to have a caesarean section (CS) out of concern to preserve pouch function.

Considering this, it is important to investigate how patients and physicians value the trade-offs between functional outcomes and mode of delivery. The study will provide important insights into the patients’ perspectives and preferences in the mode of delivery.

Collaboration with Translational Research Projects

Better understanding the microanatomic differences within inflamed and non-inflamed regions of the intestine of patients with inflammatory bowel diseases (IBD) will help to better define cellular and molecular pathways that may contribute to the development of IBD. Our team is collaborating with a team of basic science researchers, including experts in microbiology and immunology, to analyse the left-over surgical samples and to further understand the cellular interactions that may underlie disease mechanisms.

Eligible patients may be asked to participate in this study, to collect study samples at the time of surgery or endoscopy. Patients will only participate, if they have given their informed consent.

UNFASTEN-PCD

This study, led by the Ottawa Hospital, aim to determine the clinical course of perianal fistulas after seton removal in perianal Crohn’s disease (PCD). PCD impacts patients physical, psychological and sexual health. The use of loose-fitting setons is widely considered an integral component of the management of patients with complex PCD, as they play a critical role in helping to prevent abscess from recurring. However, eventually the setons need to be removed to allow for a complete closure of the fistula tracts despite patients being at risk of developing recurrent complications. There are many unknown factors around seton removals to date, such as its impact on quality of life. Therefore, this study aims to determine the natural history and impact on quality of life after seton removal.

Population Health Study: Pouch volume and Appendectomy on the Care and Management of IBD patients

By studying trends and patterns in the care and management of inflammatory bowel disease (IBD) patients in the general population, we can better understand factors that may worsen patient outcomes. In this study, we aim to study two topics by using a large province-wide health database.

1. Evidence shows that the appendix may have a protective effect on the risk ulcerative colitis (UC) development in young individuals. However, the association between appendectomy and the progression of UC remains unclear within the population of Ontario. Some studies suggest that appendectomy may be associated with a lower risk of surgery, while other studies show no association. Therefore, our study aims to better understand the relationships between the appendix and UC within the population of Ontario.
2. There have been improvements in the clinical outcomes of patients undergoing ileal pouch-anal anastomosis (IPAA) in Ontario. However, it is unclear whether this is a result of improvements in surgical technique or increased surgical experience and expertise or both. For example, patients who had IPAA done at high-volume hospitals were significantly less likely to require reoperation and excision than those who had the procedure performed at medium and low volume hospitals. Therefore, our study aims to provide an update on pouch surgery in Ontario, by investigating the changes in clinical outcomes of IPAA in UC patients and in the distribution of volumes of care across hospitals in Ontario.