Ileostomy options. Asking the right questions

The patient requiring ileostomy may have the opportunity to choose from four options. The Brooke ileostomy has afforded thousands of patients a secure, comfortable life. Appliances adhere well, and complications are few. The continent ileostomy or Kock pouch permits a patient to forego the wearing of an appliance. It is about 90 per cent successful but has a significant complication rate. Crohn's disease and physical frailties preclude its use. In "endorectal pull-through," the colon and rectal mucous membrane are removed to cure polyposis or ulcerative colitis. The ileum is led through the rectal muscular cylinder and anastomosed to the anus. The operation is tedious and not uniformly successful. A period of training must follow. It is unfit for people with Crohn's disease. Ileal anastomosis to a rectal segment is simpler but leaves disease behind. It may be used in Crohn's disease but may expose the patient to the hazard of recurrent disease or cancer. We must understand and ask the right questions if we are to give our patients the right answers.