Abstracts
1998 Digestive Disease Week

#988

THE CONTINENT ILEOSTOMY: LONG-TERM DURABILITY AND PATIENT SATISFACTION. Virginia R. Litle, Susan Barbour, Theodore R. Schrock and Mark L. Welton University of California, San Francisco, San Francisco, California.

The long-term results of continent ileostomy (C.I.), or Kock Pouch, are controversial. Methods: Durability and patient satisfaction was evaluated by analyzing the outcome in 129 consecutive patients who had a C.I. performed by one surgeon at the University of California, San Francisco between 1975 to 1995. A modified SF-36 quality-of-life questionnaire was sent to all patients with available addresses (n=121). Postoperative C.I. reoperations were classified as major (transabdominal revision and parastomal herniorrhaphy) or minor (incision and drainage of parastomal abscess, reduction of prolapse under general anesthesia, local revision of C.I. stenosis). Results: Late outcome data could be obtained for 76(59%) of the 129 patients. Total proctocolectomy (n=29), conversion from conventional ileostomy (n=30), proctectomy or colectomy (n=12) and conversion from ileoanal anastomosis (n=5) were performed at the time of C.I. creation. The indications for operation included ulcerative colitis in 71/76 (93%), familial polyposis in 4/76 (5%) and multiple neoplasms in 1/76 (1%). Forty-nine (64%) patients currently have the C.I. (Group A) (mean 15.0 years, range 2.8-21.6 years), while 27/76 (36%) have undergone conversion of C.I. to conventional ileostomy (Group B) (mean 6.1 years, range 0.2-20.4 years). Group A patients underwent fewer major postoperative procedures (mean 0.7, range 0-4) than did group B patients (mean 1.3, range 0-8). The indications for pouch removal included valve dysfunction (48%), refractory pouchitis (19%), multiple fistulas (19%) and other (19%). 89% of Group A considered their present state of health better than before their C.I. 47% of all respondents have had pouchitis (75% of Group B; 38% of Group A). 49% and 78% of all respondents were not limited in regard to vigorous or moderate activity, respectively. The overall results of the operation were considered good-excellent in 87% of respondents. Conclusion: In a third of the patients who received a C.I., the C.I. pouch ultimately had to be removed. Among the remaining two thirds, 97% have a good-excellent outcome.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.