Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone

Abstract

We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.

The failed pelvic pouch: conversion to a continent ileostomy

“…Conversion of the failed ileal pouch-anal anastomosis to a continent ileostomy is a reasonable alternative. Despite gratifying results with this procedure reported by several authors recently [11][12][13][14], most surgeons seem still to be reluctant to recommend the technique. The postoperative morbidity (the high reoperation rate in particular) has acted as a deterrent; however modifications in the original surgical technique and postoperative management have reduced the risks.…”

“…Conversion of the failing pelvic pouch to a continent ileostomy (CI) is a well-tried technique that should therefore be an attractive alternative to be considered and discussed with these unfortunate patients [11][12][13][14].…”

Results of Surgical Removal of the Pouch After Failed Restorative Proctocolectomy

“…Others have had a better experience. Hulten et al 24 reported five ileoanal pouch excisions successfully converted to a Kock continent ileostomy (only one patient required removal of the reservoir because of valve slippage), and Ecker et al 25 reported four of five successful conversions. In these studies, the period of follow-up was not stated, which may explain the difference, because in the present series the range of interval between Kock reservoirs formation and excision extend from 4 to 155 months.…”

Die kontinente Ileostomie Gegenwärtige Indikationen, Vorgehensweisen und Ergebnisse

“…Patienten mit fehlgeschlagener restaurativer Operation bleibt dadurch sowohl das inkontinente Stoma als auch unnötiger weiterer Darmverlust erspart [5]. Offensichtlich infolge des bereits vorhandenen Pouches erweist sich die Umwandlungsoperation als besonders risikoarm.…”