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Short- and Long-term Outcomes After Continent Ileostomy: An Often Forgotten Option for Patients After Proctocolectomy
Ravi P Kiran1, Beatrix H Choi, Koby Herman
1Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York.
Background:
Continent ileostomy is an alternative for reconstruction after proctocolectomy when IPAA is not feasible. Due to technical difficulties and patient preference, few centers still perform these operations. Recent literature focuses on ileostomies that are as old as 40 years, and there is a dearth of information on newly constructed continent ileostomies.
Objective:
To evaluate outcomes and patient satisfaction in a group of new continent ileostomy patients.
Design:
Retrospective case series.
Setting:
Urban academic center.
Patients:
All patients undergoing continent ileostomy creation, revision, or excision between 2013 and 2022 were included.
Intervention:
Continent ileostomy.
Main Outcome Measures:
Short-term outcomes included length of stay, complications, reoperation, and readmission within 30 days. Long-term outcomes included pouch revision, retention, quality of life, and functional outcome.
Results:
Eighty patients underwent 95 procedures. Thirty-eight patients (63% women, mean age 45 years) had their ileostomies created at our center. The mean hospitalization was 8.4 days. Readmission rate was 29%, reoperation rate was 5%, and mortality rate was 0%. Major complications (leak or pelvic abscess) occurred in 11% and minor complications (ileus, transfusions) in 58%. Pouch revision was needed in 34% of patients (major 24%, minor 11%) and pouch retention in 87% after 37 months. Forty-two patients with prior ileostomies (75% women, mean age 55 years) underwent 57 revisions/excisions. The mean hospitalization was 5.1 days; readmission rate was 7%. Major complications occurred in 6% and minor complications in 14% ot patients. There was 1 reoperation and no deaths. Repeat pouch revision rate was 21% (major 9%, minor 12%) and pouch retention rate was 88% after 42 months. Functional outcomes and quality of life on follow-up were excellent, with 92% of the creation group reporting improvement in function and quality of life and 93% of the revision group reporting improvement.
Limitations:
Retrospective design, case series.
Conclusions:
A continent ileostomy program is feasible in the contemporary era, with good short- and long-term outcomes and excellent patient satisfaction. See Video Abstract .
Resultados A Corto Y Largo Plazo Tras Una Ileostoma Continente Una Opcin A Menudo Olvidada Para Los Pacientes Tras Una Proctocolectoma:
ANTECEDENTES:La ileostomía continente es una alternativa para la reconstrucción tras la proctocolectomía cuando la anastomosis ileoanal no es factible. Debido a la dificultad técnica o a la preferencia del paciente, pocos centros aún realizan estas operaciones. La literatura reciente se centra en ileostomías con una antigüedad de hasta 40 años, con escasez de información sobre ileostomías continentes de nueva construcción.OBJETIVO:Evaluar los resultados y la satisfacción del paciente en un grupo de pacientes con ileostomía continente de nueva construcción.DISEÑO:Serie de casos retrospectiva.ESCENARIO:Centro académico urbano.PACIENTES:Todos los pacientes sometidos a creación, revisión o escisión de ileostomía continente entre 2013 y 2022.INTERVENCIÓN:Ileostomía continente.PRINCIPALES MEDIDAS DE RESULTADOS:Resultados a corto plazo (estancia hospitalaria, complicaciones, reintervención y reingreso en 30 días); resultados a largo plazo (revisión del reservorio, retención, calidad de vida y resultado funcional).RESULTADOS:80 pacientes se sometieron a 95 procedimientos. A 38 pacientes (63% mujeres, edad media de 45 años) se les realizó una ileostomía en nuestro centro. La hospitalización media fue de 8,4 días. El reingreso fue del 29%, la reintervención del 5% y la mortalidad del 0%. Se produjeron complicaciones mayores (fuga o absceso pélvico) en el 11% y complicaciones menores (íleo, transfusiones) en el 58%. La revisión de la bolsa fue del 34% (mayor 24%, menor 11%) y la retención de la bolsa fue del 87% después de 37 meses. 42 pacientes con ileostomías previas (75% mujeres, edad media de 55 años) se sometieron a 57 revisiones/escisiones. La hospitalización media fue de 5,1 días; el reingreso fue del 7%. Se produjeron complicaciones mayores en el 6% y complicaciones menores en el 14%. Hubo una reintervención y ninguna muerte. La re-revisión de la bolsa fue del 21% (mayor 9%, menor 12%) y la retención de la bolsa del 88% después de 42 meses. Los resultados funcionales y la calidad de vida durante el seguimiento fueron excelentes: el 92% del grupo de creación reportó una mejora en la función y la calidad de vida, y el 93% del grupo de revisión reportó una mejora.LIMITACIONES:Diseño retrospectivo, serie de casos.CONCLUSIONES Y RELEVANCIA:Un programa de ileostomía continente es viable en la era actual, con buenos resultados a corto y largo plazo y una excelente satisfacción del paciente. (Traducción-Dr Yolanda Colorado ).
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