Continent Ileostomy: Past Development and Current Application in Modern Colorectal Surgery

Continent ileostomy (CI) is a complex procedure performed in patients who require a total proctocolectomy and are not candidates for a J pouch and are willing to avoid wearing an external ileostomy appliance. This procedure was revolutionary in colorectal surgery as it was the first procedure offering an alternative to wearing an external appliance to catch the stool output if the patient lost the colon and rectum. CI has undergone marked evolution in techniques during the last few decades. The CI offers a high quality of life for appropriately selected patients. A major drawback of CI is the need for revision surgery in nearly half of patients in the long-term. Such revision performed in experienced hands provides retention of the continent pouch in 80% and allows patients to maintain an excellent quality of life. This review aims to summarize the historical technique of this complex procedure, complications, and present various scenarios of the current application of CI.