Progress report on the continent ileostomy

Abstract

Abstract In this paper, our 11 years of experience with the continent ileostomy is reported. Follow‐up was conducted in 280 patients with a continent ileostomy, and the results were analyzed. There was a 2.5% operative mortality rate overall, but in the last 118 consecutive patients, no operative deaths occurred. The incidence of early postoperative complications was 17% overall, and 27% in the group of patients with Crohn's disease. After modification of the operative technique, the incidence of spontaneous nipple valve desinvagination has decreased and the incidence of revisional surgery because of malfunction of the nipple valve has been reduced from 54% to 32%. Thirteen reservoirs have been removed, 5 inpatients with ulcerative colitis (2%) and 8 in patients with Crohn's disease (16%). Recurrence of Crohn's disease has occurred in 17 of 49 patients. The recurrences were confined to the ileal segment proximal to the reservoir in 6 patients, to the reservoir only in 5 patients, and to both the reservoir and the distal ileum in 6 patients. In 14 of these patients, surgical removal of diseased gut has been performed. There were 257 patients left for evaluation of the functional results. Of 29 patients from the early series without a nipple valve, 25 never used ileostomy appliances. Of 228 patients with a nipple valve, 221 (97%) were continent. The continent ileostomy procedure previously has been afflicted with high early and late complication rates. With growing experience and the introduction of methodologic modifications, the incidence of complications has been markedly reduced and, in most patients, complete continence has been achieved.