Modified techniques for improving the continent ileostomy.
Most patients will elect to have a continent ileostomy over the conventional Brooke variety if given a choice. Incontinence from valve slippage has represented a major problem. Our technique for valve construction now includes the use of an isoperistaltic ileal segment, a Marlex mesenteric sling, stapling of the valve, and cauterization of the intussuscepted, serosal bowel surface. Utilizing these maneuvers, 22 consecutive continent ileostomies have been fashioned over a period of 5 years and none has necessitated reoperation for valve slippage. Half of these were done at the time of coloproctectomy, while the remainder were Brooke ileostomy conversions. The continent ileostomy is a viable surgical procedure and represents the anatomical arrangement of choice for many patients after coloproctectomy.
D000009:Abdominal Muscles / Q000601:surgery; D003082:Colectomy; D005242:Fecal Incontinence / Q000517:prevention & control*; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008643:Mesentery / Q000601:surgery; D012007:Rectum / Q000601:surgery