T-pouch:  results of the first 10 years with a nonintussuscepting continent ileostomy.
BACKGROUND
Continent ileostomy is an alternative for patients who are either not candidates for an ileo-anal pullthrough or in whom an ileo-anal pullthrough failed. We previously described a new type of continent ileostomy (T-pouch) with a nonintussuscepting valve.


OBJECTIVE
This study performed an outcomes analysis of the first 10 years with 40 patients.


METHODS
A prospective database of patients with a T-pouch from 2000 to 2010 was retrospectively analyzed.


METHODS
The primary outcomes measured were demographics and surgical recovery information and the functional data obtained via questionnaire: incontinence, difficulty of pouch intubation, restrictions (work, social, diet, and sexual), quality of health and life, and level of satisfaction with surgery, which were rated on a scale of 0 to 10.


RESULTS
Twenty-three women and 17 men (mean age, 51.2) received a T-pouch. Median follow-up was 6.2 years (range, 0.8-11 years). Five patients (12.5%) experience a leak; 3 leaks were managed conservatively and/or with drain placement. Pouch intubations were done 4 times per day in a mean of 6.8 minutes; the insertion difficulty was rated as 2.5 of 10. Ninety-two percent achieved good continence. All quality-of-life and dysfunction/restriction scores showed significant improvement. Major abdominal surgeries for pouch-related reasons were needed in 30%; minor service operations of the skin-level stoma were needed in 25% of the patients. Of the patients, 87.5% would do the surgery again; 90% would recommend it to others with the same diagnosis.


CONCLUSIONS
This study was limited by the cohort size and the lack of long-term data.


CONCLUSIONS
Ten years with 40 patients confirmed that creation of a T-pouch is complex but could be performed with an acceptable rate of complications. It dramatically improved functional outcomes; most notably, it improved fecal control and decreased social, sexual, and work restrictions.
Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. akaiser@usc.edu
Andreas M
AM
Kaiser
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000601:surgery; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome