Abstract
Based on practical experience, a systematic approach to conversion of ileal J-pouches into continent ileostomies is developed by defining three types of conversion surgery, each with two subtypes. Type 1 refers to conversion without pouch reconstruction, type 2 to partial pouch reconstruction, and type 3 to complete pouch reconstruction. The subdivisions (a and b) take into account whether the afferent loop of the former pelvic pouch (a) or a higher ileal/jejunal segment of the small intestine (b) is used in conversion and/or reconstruction. The six resulting surgical variants are shown in schematic illustrations with accompanying descriptions of technical details to provide the specialized surgeon with comprehensive technical guidance.
Highlights
The preferred method of proctocolectomy is ileoanal pouch surgery [ileal pouch–anal anastomosis (IPAA)]
IPAA can be converted to continent ileostomy (CI) [2], an operation which was first described in detail by Kusunoki in 1990 [3]
In cases where the lumen of the afferent loop is too narrow or too wide, and/or in case of scarring or inflammatory or fibrodesmoid changes, it is advisable to move to a higher segment of the small intestine and transpose it
Summary
The preferred method of proctocolectomy is ileoanal pouch surgery [ileal pouch–anal anastomosis (IPAA)]. It has replaced its precursor, continent ileostomy (CI), because unlike CI, it preserves the normal defecation route [1]. After careful release from the pelvis, the pouch is usually completed with a nipple valve from the afferent loop [4]. This standard conversion does not succeed in all cases, and complete pouch reconstructions often have to be performed [5]. This inevitably leads to potentially unnecessary sacrifice of physiologically important small intestine.
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