Management of conventional ileostomies.

Abstract

AbstractWith few exceptions, proctocolectomy is the treatment of choice for patients with chronic ulcerative colitis. The method by which patients are offered control of bowel function postoperatively, however, is more controversial. Traditionally, proctocolectomy is accompanied by a conventional Brooke ileostomy and control of enteric effluent provided by an external appliance. Today, several alternatives are available, such as Kock's continent ileostomy and the ileoanal anastomosis. The results of both are generally good. The functional outcome of these procedures is, however, not always uniform and not all patients are candidates for such alternatives. Conventional ileostomy, therefore, remains the standard surgical approach; Brooke ileostomy is the one procedure which is applicable to any patient regardless of age, body habitus, type of disease, or other medical problems. It is the aim of this article to summarize important principles of surgical technique and of stomal care, to detail the functional results and physiologic consequences of standard ileostomy, and to document the impact of ileostomy on quality of life. Finally, the current and future role of ileostomy in the era of surgical alternatives will be discussed.