T-pouch: a new valve design for a continent ileostomy.

Abstract

After proctocolectomy for ulcerative colitis or familial adenomatous polyposis, creation of a continent ileostomy is one of the surgical options. Although most patients will be offered a pull-through procedure, the continent ileostomy is a valuable alternative in patients who are either not candidates for or have failed an ileal pouch-anal anastomosis or who--for other reasons--prefer a permanent ileostomy. The traditional continent reservoirs (Kock or Barnett pouch) with an intussuscepted bowel segment as valve mechanism have an unsatisfactorily high incidence of dysfunction and frequent reoperations. The objective of this study was to adapt the T-pouch valve concept, previously used for urinary reservoirs, for a continent stool reservoir and to construct a valve mechanism that omits intussusception of the bowel and maintains the blood supply to the valve segment. The technique for the critical valve construction is described in detail. It consists of isolating the terminal segment of the small bowel with its blood supply. The valve mechanism is created by embedding this segment in a serosa-lined tunnel of two apposed limbs of bowel that will form the pouch reservoir. Preliminary results in six patients indicate complete continence of the pouch. Although long-term results are not yet available, the new T-pouch concept is suitable as a continent stool reservoir and promises a significant improvement as compared with the traditional Kock pouch.