Complications and function of the continent ileostomy at the Cleveland clinic

We have reviewed the results of continent ileostomy management in 168 patients treated from 1977 to 1985: 83 men and 85 women ranging from 16 to 69 years of age (median, 35 yr). One hundred fifty patients were diagnosed as having ulcerative colitis originally (14 later manifested Crohn's disease), 7 had familial polyposis coli, 1 Crohn's disease, and 10 continent urostomies. Twenty‐four patients were referred with pouches made elsewhere. A total of 252 operations were undertaken to construct or reconstruct the ileostomies, with a postoperative mortality rate of 0.04% (1 case). Postoperative complications following pouch construction or revision included bowel obstruction (5.2%), hemorrhage (2.8%), and sepsis (4.8%), while valve necrosis occurred in 4 patients and there were 5 fistulas. Twenty‐nine percent of patients developed pouchitis, all treated medically. Valve extrusion occurred in 17% of cases, late fistulas in 7.1%, valve prolapse in 3%, and peristomal sepsis in 11%. Reoperation rates were 42.5% in the first 3 years of the series, 38.5% in the next 5 years, and 6.5% in the last year. The use of Marlex ® mesh in pouch construction was effective in stabilizing the valve, but led to a prohibitively high incidence of late complications and was abandoned in 1984. Ten pouches have been excised (8 of 15 done for Crohn's disease) and a total of 6 patients have died. Of the 152 patients alive with a pouch, 91% were continent. Results are encouraging and support the use of the continent ileostomy in patients unsuited for ileoanal pouch procedures.