Short- and Long-term Outcomes After Continent Ileostomy, an Often Forgotten Option for Patients After Proctocolectomy.

Abstract

Background: The continent ileostomy is an alternative for reconstruction after proctocolectomy when the ileal pouch-anal anastomosis is not feasible. Due to technical difficulty and patient preference, few centers still perform these operations. Recent literature focuses on ileostomies that are as old as 40 years with a dearth of information on newly constructed continent ileostomies.

Objective: To evaluate outcomes and patient satisfaction in a group of new continent ileostomy patients.

Design: Retrospective case series.

Setting: Urban academic center.

Patients: All patients undergoing continent ileostomy creation, revision, or excision between 2013 and 2022.

Intervention: Continent ileostomy.

Main outcome measures: Short-term outcomes (length of stay, complications, reoperation, and readmission within 30 days); long-term outcomes (pouch revision, retention, quality of life, and functional outcome).

Results: Eighty patients underwent 95 procedures. 38 patients (63% female, mean age 45) had their ileostomies created at our center. Mean hospitalization was 8.4 days. Readmission was 29%, reoperation 5% and mortality 0%. Major complications (leak or pelvic abscess) occurred in 11% and minor complications (ileus, transfusions) in 58%. Pouch revision was 34% (major 24%, minor 11%) and pouch retention was 87% after 37 months. 42 patients with prior ileostomies(75% female, mean age 55) underwent 57 revisions/excisions. Mean hospitalization was 5.1 days; readmission was 7%. Major complications occurred in 6% and minor complications in 14%. There was one reoperation and no deaths. Repeat pouch revision was 21% (major 9%, minor 12%) and pouch retention 88% after 42 months. Functional outcomes and quality of life on follow-up were excellent, with 92% of the creation group reporting improvement in function and quality of life, and 93% of the revision group reporting improvement.

Limitations: Retrospective design, case series.

Conclusions and relevance: A continent ileostomy program is feasible in the contemporary era, with good short- and long-term outcomes and excellent patient satisfaction. See Video Abstract.