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Background/aim: Continent ileostomy (CI) is a surgically created intra-abdominal pouch in patients with a permanent end ileostomy. CI is one of the few surgical options that may be offered to patients who were fated to live with a permanent ileostomy, but want to avoid a stoma appliance at any cost. Data about durability, clinical and functional outcomes of CI created in pediatric patients are limited. In this study, we aimed to evaluate our 36-year operative experience on CI in pediatric patients with a 21 year median follow-up.
Methods: Pediatric (≤21 years)* patients undergoing a CI procedure at a single institution from 1973-2009 were identified. CI revisions that required pouchotomy or re-construction following total or partial excision of CI were defined as major and those that did not require bowel resection were defined as minor revisions. CI failure was defined as excision of the pouch and formation of an end ileostomy.
Results: 49 patients (26 male), median age 18 (12-21) years and median body mass index 22 (16-38.6) underwent CI. 10 (20%) patients had a CI at the time of total proctocolectomy. 12 (25%) patients underwent conversion of an ileoanal pouch (IPAA) to a CI. The majority of the patients (n=39, 80%) had ulcerative colitis or indeterminate colitis at the time of CI creation; however Crohn's disease were diagnosed in 4 patients postoperatively. There were no intra-operative or early post-operative deaths. One patients who underwent CI excision seven years after CI creation due to complicated Crohn's disease, died ten years after CI excision. Median follow-up time was 21(range 1-38) years. Valve slippage (33%), small bowel obstruction (25%), pouchitis (25%) and fistula (23%) were the common complications (table). 37 patients (76%) underwent at least 1 revision procedure after CI creation. 36 (74%) patients underwent major revision and 6 (12%) patients underwent minor revisions. Median pouch intubation was 6 (range 4-10) times per day. Pouch failure occurred in 9 (18%) patients with 7 out of 9 cases being due to complications from Crohn's disease.
Conclusions: CI is safe and durable in pediatric patients. Development of Crohn's disease after CI creation seems to be a risk factor for failure. Since likelihood of further revisions is high, patients with CI should be followed-up regularly.
* Council on Child and Adolescent Health. Age Limits of Pediatrics. Pediatrics 1988;81:736.
Primary diagnosis, complications and follow-up details

Primary diagnosis	n (%)
Ulcerative colitis	35 (71 %)
Familial adenomatous polyposis	4 (8 %)
Indeterminate colitis	4 (8 %)
Crohn's disease	4 (8 %)
Motility disorder	2 (4%)
Complications
Valve slippage	16 (33 %)
Small bowel obstruction	12 (25 %)
Pouchitis	12 (25 %)
Fistula	11 (23 %)
Difficult intubation	9 (18 %)
Incontinence	8 (16 %)
Leakage	8 (16 %)
Valve prolapse	7 (14 %)
Bleeding	4 (8 %)
Afferent limb stricture	3 (6 %)
Ventral hernia	3 (6 %)
Parastomal hernia	2 (4 %)
Exit conduit stricture	2 (4 %)
Follow up functional details #
Time to first major revision after CI creation (years)	2 (0.5-30)
Time to first minor revision after creation of CI (years)	2 (0.1-5)
Time to CI excision after CI creation (years)	5 (2-28)

# Results presented as median (range)