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Failed pelvic pouch substituted by continent ileostomy
1Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. hans.wasmuth@stolav.no
Summary
Conversion to continent ileostomy (CI) offers an alternative to permanent ileostomy after failed ileal pouch-anal anastomosis (IPAA). This approach preserves ileal length and pouch function, with most patients achieving continence.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Gastroenterology
Background:
- Ileal pouch-anal anastomosis (IPAA) has a 10-15% long-term failure rate.
- Pouch excision with conventional ileostomy sacrifices significant ileal length.
- Continent ileostomy (CI) preserves ileal surface and pouch properties.
Purpose of the Study:
- To evaluate the clinical outcome of converting failed IPAA to a continent ileostomy (CI).
- To assess CI as an alternative to pouch excision and permanent ileostomy.
Main Methods:
- Retrospective analysis of 11 patients with IPAA failure who underwent conversion to CI between 1984-2007.
- CI constructed either from transposing pelvic pouch or a new ileal segment.
- Median follow-up of 7 years.
Main Results:
- 8 out of 11 patients achieved full continence at follow-up.
- Two CI required removal due to fistulae; one needed nipple valve revision.
- One patient with Crohn's disease experienced minor leakage.
Conclusions:
- Conversion to CI is a viable alternative to pouch excision for failed IPAA, offering improved continence and body image.
- Construction of CI from a new ileal segment is possible but requires careful consideration of small bowel loss and malnutrition risks.
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Introduction
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
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