The Essentialsof Pouch Care

NursingEDITED BY

JULIA WILLIAMS MEd, BSC(HONS), RGN, DIPD/NLecturer in Gastro-intestinal Nursing,

St Marks Hospital, Harrow

WW H U R R P U B L I S H E R S

L O N D O N A N D P H I L A D E L P H I A

Innodata047003131X.jpg

The Essentials of Pouch Care Nursing

DedicationTo my family

The Essentialsof Pouch Care

NursingEDITED BY

JULIA WILLIAMS MEd, BSC(HONS), RGN, DIPD/NLecturer in Gastro-intestinal Nursing,

St Marks Hospital, Harrow

WW H U R R P U B L I S H E R S

L O N D O N A N D P H I L A D E L P H I A

2002 Whurr Publishers LtdFirst published 2002by Whurr Publishers Ltd19b Compton TerraceLondon N1 2UN England and325 Chestnut Street, Philadelphia PA 19106 USA

All rights reserved. No part of this publication may be repro-duced, stored in a retrieval system, or transmitted in any form orby any means, electronic, mechanical, photocopying, recordingor otherwise, without the prior permission of Whurr PublishersLimited.

This publication is sold subject to the conditions that it shall not,by way of trade or otherwise, be lent, resold, hired out, or other-wise circulated without the publishers prior consent in any formof binding or cover other than that in which it is published andwithout a similar condition including this condition beingimposed upon any subsequent purchaser.

British Library Cataloguing in Publication Data

A catalogue record for this bookis available from the British Library.

ISBN 1 86156 221 7

Printed and bound in the UK by Athenaeum Press Ltd,Gateshead, Tyne & Wear.

v

Contents

Foreword viiContributors ixAcknowledgements xiSponsor statement xiii

Chapter 1 1

Medical aspects of ulcerative colitisAlastair Forbes

Chapter 2 27

Familial adenomatous polyposis Kay Neale and Robin Phillips

Chapter 3 43

Carcinoma of the rectumJohn Northover, Claire Taylor and Darren Gold

Chapter 4 68

The ileo-anal pouchR. John Nicholls and Julia Williams

Chapter 5 99

The Kock pouch and nursing careJulia Williams and Peter Hawley

Chapter 6 117

The colo-anal pouch and nursing careRobin Phillips and Julia Williams

Chapter 7 128

Continent urinary diversions and rectal bladdersRachel Leaver

Chapter 8 143

Controversies and problem-solving with regard to ileo-anal pouchesJulia Williams and R. John Nicholls

Chapter 9 165

Dietary aspects of internal pouchesMorag Pearson

Chapter 10 180

Sexual aspects of internal pouch surgeryMave Salter

Chapter 11 199

Children and internal pouchesGail Fitzpatrick, Pat Coldicutt and Julia Williams

Chapter 12 218

Patients perspectives as told to Julia Williams

Useful addresses 235References 239Index 257

vi The essentials of pouch care nursing

vii

Foreword

The introduction of the ileal reservoir by Kock in the late 1960s toimprove quality of life for the ileostomist was the start of a long devel-opment in intestinal surgery. Soon afterwards, restorative procto-colectomy with ileoanal reservoir was designed by Parks in order toavoid ileostomy altogether. Subsequently, the use of the colonicreservoir by Lazorthes aimed to improve bowel function in patientswith low anterior resection. Thus, pouch surgery has been applied toinflammatory bowel disease, rectal cancer and familial adenomatouspolyposis, becoming an important part of specialist colorectalsurgery.

Pouches have much to do with quality of life, and this to a degreedepends on the subjective perception of the patient. The discussionof indications, including counselling, is thus a vital element of achiev-ing an optimum result. Following surgery, the patient requires help indealing with normal recovery even more so in the event of complications. Long-term follow-up and continued support afterleaving hospital are therefore necessary. It is with these aspects ofcare that specialist nurses can help in a way that doctors cannoteasily do. They have a different perspective on the patients dilemmaof choice of procedure and on the consideration of possible disad-vantages. In addition, they can, by their accessibility, more readilyoffer continuity of care and advice.

Decision-making, preparation for surgery, the intermediate post-operative course and longer-term outcomes all come within theambit of this excellent book. The vast amount of information avail-able on pouches has been summarised in various chapters to enablea rapid and easy access to important issues, both surgical and

nursing. The Essentials of Pouch Nursing is the first book of its kind. Itfills an educational gap and will be essential reading for any health-care professional with an interest in colorectal reconstructive surgery.It deals with all the diseases amenable to pouch formation, as well aswith various techniques and aftercare, in a highly practical manner.

Professor R. John NichollsSt Marks Hospital, Harrow

July 2001

viii Acute Mental Health Care in the Community: Intensive Home Treatment

ix

Contributors

Pat Coldicutt BA(Hons) RGN RSCN DPSN Clinical Nurse Special-ist Stoma Care, Alder Hey Childrens Hospital, Liverpool

Gail Fitzpatrick RGN RSCN Clinical Nurse Specialist StomaCare, The Birmingham Childrens Hospital NHS Trust, Birm-ingham

Alastair Forbes BSc MD FRCP Consultant Physician, North WestLondon Hospitals Trust, St Marks Hospital, Harrow, Middlesex

Darren Gold MSc FRCS(Gen) Senior Registrar, North WestLondon Hospitals Trust, St Marks Hospital, Harrow, Middlesex

Peter Hawley MS FRCS Consultant Surgeon, The London Clinic,Harley Street, London

Rachel Leaver BSc(Hons) RGN Clinical Nurse Specialist Conti-nent Urinary Diversions, UCL Hospitals NHS Trust, St. PetersHospital, London

Kay Neale MSc SRN Registrar, The Polyposis Registry, North WestLondon Hospitals Trust, St. Marks Hospital, Harrow, Middlesex.

R. John Nicholls MA Mchir FRCS FRCPS(Glas) ConsultantSurgeon, Clinical Director, North West London Hospitals Trust,St Marks Hospital, Harrow, Middlesex

John Northover MS FRCS Consultant Surgeon, North WestLondon Hospitals Trust, St Marks Hospital, Harrow, Middlesex

Morag Pearson BSc (Hons), SRD Senior Dietician, North WestLondon Hospitals Trust, St Marks Hospital, Harrow, Middlesex

Robin Phillips MS FRCS Consultant Surgeon and Dean, St MarksAcademic Institute, North West London Hospitals Trust, StMarks Hospital, Harrow, Middlesex

x The essentials of pouch care nursing

Mave Salter MSc BSc(Hons) RGN BNDN(Cert) CertEdRNT ENB216 CSCT Clinical Nurse Specialist, The Royal Marsden Hospital NHS Trust, Sutton, Surrey

Claire Taylor MSc BSc RGN Colorectal Macmillan Nurse Special-ist, North West London Hospitals Trust, St Marks Hospital,Harrow, Middlesex.

Julia Williams MEd BSc(Hons) RGN Dip DN Lecturer in Gastro-intestinal Nursing, North West London Hospitals Trust,St Marks Hospital, Harrow, Middlesex

xi

Acknowledgements

I would like to thank all those who contributed a chapter to thisbook.

Special thanks go to my colleagues within the Stoma CareDepartment, St Marks Hospital, particularly Professor R. JohnNicholls, for supporting me throughout this project. I am also grate-ful to Dansac Ltd for making the vision become true.

Finally, sincere thanks go to my family and friends for theircontinued support and encouragement.

Dansac Limited are proud to have beeninvited to support Julia Williams with thisvery important publication.

Dansac Limited believes that as a leadingmanufacturer within the stoma care market,we have a responsibility to health-care profes-sionals to help provide continuing educationand support wherever appropriate.

We are pleased to have provided financialsupport for this book, and to have donated acopy to each Stoma Care Departmentwithin the UK.

xiii