John Nicholls (surgeon)

Ralph John Nicholls (born 20 May 1943), FRCS (Eng), EBSQ is a retired British colorectal surgeon, Emeritus Consultant Surgeon at St Mark's Hospital London and Professor of Colorectal Surgery, Imperial College London.

R. John Nicholls is best known for his work in the development of ileal pouch surgery. With the advancement of ileal-anal pouch surgery, selected patients with ulcerative colitis and familial adenomatous polyposis (FAP) requiring surgery can be treated by removing the diseased colon also known as the large intestine and rectum while preserving the anus, thereby avoiding a permanent stoma (ileostomy). This revolutionary operation challenged the conventional procedure used at the time, total procotocolectomy, which included removal of the anal sphincter leaving the patient with an ileostomy for life.

The technique of ileal pouch-anal anastomosis (IPAA) surgery, also known as restorative procotocolectomy (RPC) consists of removal of the diseased colon and rectum, immediately followed by the creation of a surgical join (anastomosis) between the small intestine (ileum) above and the anus below. The reservoir function of the rectum lost by its removal was replaced by the surgical construction of a 'new' rectum made from the ileum to form a so-called "ileal pouch". This enabled the patient requiring surgery for ulcerative colitis and some with familial adenomatous polyposis to avoid a permanent ileostomy by enabling the storage of stool in the pouch as would normally occur in the rectum to be followed by defaecation through the anus at the patient's convenience.

The drive behind creating and developing ileo-anal pouch surgery was to improve the quality of life for select patients who required surgery for their condition and were medically suitable to undergo the procedure. The decision to undergo the pouch operation was made by the patient based on objective information and their preference between life with a permanent ileostomy or the preservation of defaecation through the anus, in each case with the removal of the disease.

The pouch operation with anal anastomosis was designed to be the patient's choice between life with an ileostomy or they could choose an elective/optional pouch reconstruction after the colon and rectum needed to be removed due to disease. The Kock pouch procedure developed by Finnish surgeon Nils Kock first reported in Sweden in 1969 which is a continent ileostomy, was also an attempt to improve the patient's quality of life, but it still required an opening of the bowel onto the abdominal wall, rather than preservation of the normal route of defaecation through the anus as in restorative proctocolectomy.