Improved results with continent ileostomy

The objective of this study was to determine if recent technical modifications have improved our results with continent ileostomy (Kock pouch). The modifications were that the valve of the pouch was made at least 5 cm in length and was anchored with specially placed, nonabsorbable sutures or staples. The pouch was drained continuously for the first four postoperative weeks, after which it was only gradually allowed to expand. Results from our first 149 patients were compared to those from our last 150 patients, in whom the modified approach was used. The age, sex, indications for operation and types of operation were similar in the early and late groups. No postoperative deaths occurred, and the incidence of continence at dismissal from hospital was near 100% in both groups. However, 15 pouches were excised in the early group as opposed to only five in the late group (p < 0.01). Moreover, the need for revision of the valve by one year was 43% in the early group but only 22% in the late group (p < 0.001). Long-term follow-up showed that complete continence was present in 60% of patients in the early group and 75% of patients in the later group (p < 0.05), although only about 5% of patients in either group wore an ileostomy bag. We concluded that recent technical changes have improved the results after continent ileostomy.