Outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis

Abstract

Purpose: Continent ileostomy is considered an alternative for patients with a failed ileal pouch-anal anastomosis. The aim of this study is to investigate outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis at our institution.

Methods: Patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis were identified from a prospectively maintained pouch database. Quality-of-life scores were obtained by telephone follow-up or office visit and were determined by the Cleveland Global Quality of Life Score.

Results: Sixty-four patients were identified between 1982 and 2007. Forty-two percent were male. The median age was 36.5 (range, 14-61) years. Most common diagnoses included ulcerative colitis (n = 44, 68.8%) and Crohn's disease (n = 13, 20.3%). The indication for continent ileostomy was septic pouch complications in 56.3% patients. The previous pelvic pouch was used in 16 (25%) patients. The 30-day complication rate was 31.3%. There were no perioperative deaths. Median follow-up was five years. The long-term dysfunction rate was 50%, the complication rate was 60.9%, and the revision rate 45.3%. The median revision-free interval was 2.8 years (range, 3 months to 19 years) and the retention rate of continent ileostomy was 95.3% (61 of 64). Median continent ileostomy survival time was 4.2 (range, 1-19) years. The median quality-of-life score was 0.77.

Conclusions: Continent ileostomy is possible in patients wishing to avoid an external appliance after pelvic pouch failure. Despite the associated morbidity, most of this select group of highly motivated patients retain their continent ileostomy long-term and are highly satisfied with their choice of continent ileostomy.