The continent ileostomy

Abstract

AbstractThe object of this article is to evaluate the results with the continent ileostomy and to define its place as a therapeutic alternative after proctocolectomy. In the past, the method has been affected by a high incidence of complications, but technical developments, simplifications, and improvements in surgical techniques have reduced the incidence of early complications from 20–25% to less than 10%, and that of late complications from 45–54% to 10–22%. The mortality rate in several recently published series of 1,142 patients was 0–1% (mean 0.2%), none of the deaths being directly pouch related. Fifteen to 20% of patients develop ileitis, which is usually successfully treated with antibiotics. Eighty‐nine to 97% of the patients never require external ileostomy appliances, indicating perfect continence. No serious adverse effects have been found after 19 years' experience with the method, but a few patients have developed subnormal values of vitamin B12. More than 90% of patients who have previously had a conventional ileostomy claim improvements in social life and sports activities and 68–85% found that the quality of their sexual life had improved. There is no doubt that a well‐functioning continent ileostomy offers the patients a quality of life superior to that with a conventional ileostomy. Despite the increasing popularity of the pelvic reservoir and ileoanal anastomosis, the continent ileostomy remains a therapeutic alternative for proctocolectomized patients undergoing conversional procedures and for patients in whom ileoanal anastomosis with pelvic reservoirs are contraindicated or impossible to construct.