[Artificial anus. Advantages and disadvantages of ileo- and colostomy]

The majority of patients with ileostomy adapt to their new situation and are able to live a nearly normal professional and social life. This does not mean that there is not a need for improvement in the ileostomy construction. It merely proves the great adaptive mechanism in man. In spite of the improvement in surgical techniques in the construction of the ileostomy and the development of modern ileostomy appliances, a proportion of the patients still experiences serious problems. In order to improve the situation for patients with ileostomy a new type of ileostomy has been developed. From the terminal ileum an intraabdominal, intestinal reservoir is constructed and the outlet from the reservoir is provided with a "nipple valve" preventing leakage of gas and faeces through the outlet. The continent ileostomy has now been under clinical trial for more than seven years. The success-rate has increased along with improvements in technique and introduction of methodological modifications. More than 90% of 164 patients provided with this type of ileostomy had at follow-up satisfactory functional results of their ileostomy. That means that they had no need for carrying external ileostomy appliances. A method for constructing a continent colostomy has been tested in dogs. The sigmoid colon was divided and the distal end closed. At the proximal end a "nipple valve" was constructed by intussuscepting a part of the intestine into its lumen. All dogs were continent from the time of operation until they were sacrificed one to eight weeks later. The method is now under elaboration for clinical trial.