Lian L, Fazio VW, Remzi FH et al. Dis Colon Rectum 2009;52:1409–16.
These investigators conducted a retrospective analysis of outcomes in patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis. Overall, 64 patients at the authors’ institution underwent the procedure over a 25-year period. Surgical revision was required in 45% of the patients during the follow-up period (median 5 years); however, 95.3% of the continent ileostomies were retained to the end of follow-up. This procedure, although infrequently performed, represents a viable alternative to standard ileostomy.
Continent ileostomy, which is an ileostomy that drains into a surgically created pouch or reservoir in the abdomen, was first described by Nils Kock of Gothenburg, Sweden, in 1969 [1]. It may be offered to patients as an alternative to standard ileostomy, particularly in cases in which ileo-anal pouch surgery has failed or is not an option. The current authors report a retrospective analysis of continent ileostomies performed at the Cleveland Clinic, Cleveland, OH, USA. Data were obtained by searching a prospectively maintained database of ileo-anal pouches for failed ileo-anal pouches between 1982 and 2007. At the time of the original pouch surgery, all patients had been informed of the alternatives to the ileo-anal pouch, including the possibility of repeat pouch surgery, formation of a continent ileostomy, or a standard end-ileostomy.