Long‐term outcome and quality of life after continent ileostomy for ulcerative colitis: A systematic review

Abstract

Aim The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC) when a restorative option is not suitable or has not succeeded and the patient does not want a conventional end ileostomy. Continent ileostomy types include the Kock pouch, Barnett continent intestinal reservoir and T‐pouch. All of the published evidence on the long‐term outcome and quality of life after continent ileostomy for UC was systematically reviewed. Methods A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies published between 1990 and 2020 were included. A descriptive synthesis was used due to the clinical heterogeneity. Results The search returned 1655 abstracts and after screening of abstracts and full text review, 19 were included in the final review, involving 1602 patients. Operative mortality is low (0%–3.6%) after all types of continent ileostomy but reoperation rates are high (20.8%–65%) because of valve mechanism failures. Rates of fistulae (0%–25.5%) and stomal stenosis (0%–25%) can be relatively high postoperatively. Quality of life scores improve for most patients undergoing continent ileostomy, especially for patients converted from ileal pouch anal anastomosis. Overall, continent ileostomy retention is high in the long‐term. Discussion In the long‐term, patients report high satisfaction and a good quality of life with continent ileostomy, despite high reoperation rates and complications. Newer technologies may reinvigorate interest in the continent ileostomy for this population.

Don't Forget about the K-Pouch!

“…32 Conversely, a systematic review of UC patients undergoing CI creation reported high rates of pouch survival, low rates of anastomotic leaks, and excellent QOL (notably with similar QOL outcomes as IPAA). 45 The authors strongly recommend caution when approaching the CD patient requesting a CI, even if the individual has been well for years after proctocolectomy. They commonly suffer complications and stand to lose a long segment of precious small intestine and risk sequelae of the dreaded short bowel syndrome.…”

Construction of and Conversion to Continent Ileostomy: A Systematic Review

“…As we mentioned above, a majority of valve complications occur in the first year after CI construction. 5,6 A systematic review of 19 studies in CI by Deputy et al 32 reported a rate of slippage of 15.8% (mean follow-up, 12.5 years) to 57% (mean follow-up, 7 years). The weakest point of the valve is at the mesenteric aspect where intussusception produces a large bulk of fatty mesentery that prevents the 2 walls of the valve from firmly attaching.…”

“…18 Possible complications are listed in Table 4, and their frequency is listed in Table 5. 9,11–17,20,22–24,31,32…”

“…18 Possible complications are listed in Table 4, and their frequency is listed in Table 5. 9,[11][12][13][14][15][16][17]20,[22][23][24]31,32 One of the most common complications and the most common reason for revision of K-pouches is slippage of the nipple valve (causing up to 84% of reoperations 19 ) (Fig. 5; compare with normal Fig.…”

Re-do Continent Ileostomy in Inflammatory Bowel Disease Patients: Valuable Lessons Learned Over 25 years

“…2 When complications occur, patients with CI and good QOL may want to keep their CI and undergo redo CI instead of having a permanent ileostomy. 10,11 There remains a paucity of data regarding outcomes after redo CI.…”