Surgical load and long-term outcome for patients with Kock continent ileostomy.
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.
Wasmuth
H H
HH
Department of Surgery, St. Olavs Hospital HF, University Hospital of Trondheim, Trondheim, Norway. hans.wasmuth@stolav.no
Svinsås
M
M
Tranø
G
G
Rydning
A
A
Endreseth
B H
BH
Wibe
A
A
Myrvold
H E
HE
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome