Closing Remarks

Although in the era of restorative proctocolectomy it is hard to accept that a reservoir ileostomy may be a satisfactory alternative to the ileal anal-pouch, it cannot be denied that, recently, many have reported rewarding results with the continent ileostomy even after a long-term follow-up. In 2004, Berndtsson et al. analysed data from 68 patients operated on with continent ileostomy between 1967 and 1974 to assess the long-term pouch durability and the health-related quality of life. The median follow-up was 31 years. The majority of patients reported good physical condition and satisfactory pouch function. Patients emptied the pouch a median of four times every day and 65% of patients had at least one post-operative revision to restore continence. The quality of life scores were compared to those of a control group. Seventy-eight percent of the patients rated their overall health as good, very good or excellent and the scores were comparable to the reference values [30]. Likewise, in 2005, Castillo reported a retrospective study in which the results of 24 patients operated on with a modified Kock pouch between 1993 and 2003 were evaluated. The median follow-up was 66 months. The underlying disease was ulcerative colitis in 71% of the patients, 20 patients had already been operated on: 13 patients were converted from a Brooke ileostomy to a continent ileostomy and 7 patients were operated on for a failure of a previous ileal anal-pouch. Revisional operations were performed in 58% of patients. The failure rate with reconversion to conventional ileostomy was only 8.3%, and 90% of the patients were satisfied with the continent pouch [31].

Although a high rate of reoperations may be needed to restore continence, continent ileostomy has good durability, satisfactory pouch function or quality of life, which are, in most cases, similar to that of the normal population. Therefore, the results reported make this procedure a viable option for patients with a previous restorative proctocolectomy that has failed, or whenever a restorative proctocolectomy is not likely to be advisable for the reasons discussed above. However, the patients must be carefully selected and before performing a reservoir ileostomy, they should always be advised of the high risk of revisional operations. Moreover, despite the high reoperation rate, most patients are reported to be pleased with continent ileostomy and, even in the case of reservoir failure or dysfunction, when they are asked to choose, most of them prefer to cope with revision operations rather than manage a conventional ileostomy for their entire lifetime [8].

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