Modified techniques for improving the continent ileostomy

Most patients will elect to have a continent ileostomy over the conventional Brooke variety if given a choice. Incontinence from valve slippage has represented a major problem. Our technique for valve construction now includes the use of an isoperistaltic ileal segment, a Marlex mesenteric sling, stapling of the valve, and cauterization of the intussuscepted, serosal bowel surface. Utilizing these maneuvers, 22 consecutive continent ileostomies have been fashioned over a period of 5 years and none has necessitated reoperation for valve slippage. Half of these were done at the time of coloproctectomy, while the remainder were Brooke ileostomy conversions. The continent ileostomy is a viable surgical procedure and represents the anatomical arrangement of choice for many patients after coloproctectomy.