Appropriate specialist expertise

Appropriate specialist expertise

Statement 5.2

Elective IBD surgery should be performed by a recognised colorectal surgeon (paediatric colorectal surgeon where appropriate) who is a core member of the IBD team in a unit where such operations are undertaken regularly.

Statement 5.3

In the absence of relevant local expertise, paediatric patients or adult patients requiring complex surgery should be referred to a specialist unit.

Why is it important?

Patients are more likely to have better outcomes if their IBD surgery is undertaken by a colorectal surgeon with relevant expertise and experience and supported by an experienced clinical team.

The surgeon should be able to make informed decisions about the timing and need for surgery.

They should have a substantial amount of their working time devoted to IBD, be a core member of the IBD multidisciplinary team, and most likely in a unit where this kind of surgery is performed regularly. The clinical team’s expertise and experience will help ensure surgery is undertaken at the right time – as well as the quality of clinical care before, during and after surgery.

If this expertise isn’t available locally, patients who need either elective or urgent surgery should be referred to a specialist unit. Referral to a unit with specialist expertise should be considered for IBD patients with complex or recurrent disease, including revision and excision pouch surgery, rectovaginal fistula, Kock pouch and in adolescence.

With emergency procedures, these may sometimes have to be performed by a surgeon who has appropriate skills and experience, but less specialist experience.

Children and young people need particular attention. It’s also important for operations to be carried out by surgeons with specific experience of children and young people with IBD. This should always follow discussion with a dedicated paediatric gastroenterologist.

Where local paediatric surgeons lack experience of the relevant procedure, it may be necessary to either perform surgery jointly with a colorectal surgeon or refer to a paediatric surgeon with the necessary experience.

Patients need to be able to make truly informed decisions about operations.

Prof. Omar Faiz, Consultant Colorectal and Intestinal Surgeon