title: Surgical load and long-term outcome for patients with Kock continent ileostomy.
abstract: OBJECTIVE
  The aim of the study was to evaluate the results of Kock continent ileostomy (CI) during the same period when ileal pouch-anal anastomosis was the preferred operation for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP).
  
  
  METHODS
  During the period 1983-2002, 50 patients underwent CI. The surgical technique was unchanged during the period. Follow-up included all patients. Forty-eight patients had UC, two of these had the diagnosis later changed to Crohn's disease and two had FAP.
  
  
  RESULTS
  Twenty-two patients had 38 reoperations, four (8%) of whom had the pouch removed. The main causes for reoperation included leakage and difficulty in intubation due to sliding of the nipple valve (42%), fistula formation (29%) and stenosis (21%). Seventeen (45%) underwent a revision of the nipple valve and the pouch and nine (24%) a local procedure. The reoperation rate was higher among patients having a conventional ileostomy converted to CI than among those having CI. As a primary procedure (P = 0.016). The risk of a second reoperation was higher for those reoperated within the first year after having a CI, than for those reoperated later (P = 0.007).
  
  
  CONCLUSIONS
  The reoperation rate of patients with CI is high but the removal rate of the pouch is low and is not associated with a high rate of revision. CI is a good alternative to conventional ileostomy in patients not suitable for restorative proctocolectomy or where this procedure has failed.
authors.affiliation: Department of Surgery, St. Olavs Hospital HF, University Hospital of Trondheim, Trondheim, Norway. hans.wasmuth@stolav.no
authors.forename: H H
authors.initials: HH
authors.lastname: Wasmuth
authors.forename: M
authors.initials: M
authors.lastname: Svinsås
authors.forename: G
authors.initials: G
authors.lastname: Tranø
authors.forename: A
authors.initials: A
authors.lastname: Rydning
authors.forename: B H
authors.initials: BH
authors.lastname: Endreseth
authors.forename: A
authors.initials: A
authors.lastname: Wibe
authors.forename: H E
authors.initials: HE
authors.lastname: Myrvold
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome