Construction of and Conversion to Continent Ileostomy: A Systematic Review

Area of Science:

• Surgical Oncology
• Gastroenterology
• Restorative Proctology

Background:

• Continent ileostomy, or Kock pouch (K-pouch), was developed in 1969, with a nipple valve for continence added later.
• While often superseded by ileal pouch-anal anastomosis (IPAA), it remains a valuable option for specific colectomy patients.
• It serves as an alternative to end ileostomy or malfunctioning ileoanal pouches.

Approach:

• A systematic review of PubMed and Cochrane Library up to July 2021.
• Included studies focused on continent ileostomy procedures and outcomes from 2000-2021.
• Excluded case reports and series with fewer than 15 patients.

Key Points:

• Fifteen articles were reviewed, encompassing 958 K-pouch patients, 510 Barnett continent intestinal reservoir patients, and 40 T-pouch patients.
• Continent ileostomies performed in specialized centers yield high pouch survival and improved quality of life compared to end ileostomy.
• Outcomes are comparable to IPAA, despite potential reoperation and complication rates.

Conclusions:

• Continent ileostomy is a viable option for patients avoiding end ileostomy, offering enhanced quality of life.
• Careful patient selection, education, motivation, and engagement are paramount for success.
• Further research is needed for Crohn's disease patients, and technique refinement can expand suitability.