Long-term outcome and quality of life after continent ileostomy for ulcerative colitis: A systematic review.

Mohammed Deputy,Mattias Block,Guy Worley,Tom Øresland,Jordan Fletcher,Komal Patel,Pär Myrelid,Omar Faiz,Ailsa Hart

doi:10.1111/codi.15788

Abstract

The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC) when a restorative option is not suitable or has not succeeded and the patient does not want a conventional end ileostomy. Continent ileostomy types include the Kock pouch, Barnett continent intestinal reservoir and T-pouch. All of the published evidence on the long-term outcome and quality of life after continent ileostomy for UC was systematically reviewed. A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2020 were included. A descriptive synthesis was used due to the clinical heterogeneity. The search returned 1655 abstracts and after screening of abstracts and full text review, 19 were included in the final review, involving 1602 patients. Operative mortality is low (0%-3.6%) after all types of continent ileostomy but reoperation rates are high (20.8%-65%) because of valve mechanism failures. Rates of fistulae (0%-25.5%) and stomal stenosis (0%-25%) can be relatively high postoperatively. Quality of life scores improve for most patients undergoing continent ileostomy, especially for patients converted from ileal pouch anal anastomosis. Overall, continent ileostomy retention is high in the long-term. In the long-term, patients report high satisfaction and a good quality of life with continent ileostomy, despite high reoperation rates and complications. Newer technologies may reinvigorate interest in the continent ileostomy for this population.

Highlights

The aim of a continent ileostomy is to provide the patient control over the evacuation of an ileal reservoir at a time convenient to them
It was constructed for patients after colectomy for ulcerative colitis (UC) or familial adenomatous polyposis in the era before restorative surgery
The continent ileostomy still plays a role in those patients for whom an ileal pouch anal anastomosis (IPAA) is not suitable, or where an IPAA may have failed

Summary

Introduction

The aim of a continent ileostomy is to provide the patient control over the evacuation of an ileal reservoir at a time convenient to them. The continent ileostomy was first described by Kock in 1969 [1]. It comprises a small bowel pouch which leads to an intussusceptive valve that prevents flow of ileal contents (see Figure 1). It was constructed for patients after colectomy for ulcerative colitis (UC) or familial adenomatous polyposis in the era before restorative surgery. The continent ileostomy still plays a role in those patients for whom an ileal pouch anal anastomosis (IPAA) is not suitable, or where an IPAA may have failed. Patients with a conventional ileostomy who would prefer not to have an external appliance may opt for conversion to a continent ileostomy

Objectives

Methods

Findings

Discussion

Conclusion