Continent ileostomy. It is a surgical procedure at the level of the rectum.
Summary
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- 1 Summary
- 2 Patients and methods
- 3 Surgical technique
- 4 Post-operative care
- 5 Results
- 6 Source
- 7 External links
Summary
The continent ileostomy was introduced into surgical practice by N. Kock in 1969. From that moment on, this author modified the surgical procedure repeatedly until obtaining the one currently used.
Due to the good results achieved with this procedure, which avoids the need for patients to use the stool collection bags, different authors introduced this technique in Anglo-Saxon countries. However, the problems encountered in this procedure, especially at the level of valve preparation, and the advent of other techniques, such as ileoanal anastomosis with a reservoir, which allow patients who still have the rectum to avoid performing an ileostomy , have led to a more precise selection of the indications for this technique.
Patients and methods
The intervention was performed in 16 patients, 4 diagnosed with colonic adenomatous polyposis and 12 with ulcerative colitis. Of the 4 polyposis patients, 3 had a malignancy, two classified as stage B and one classified as Dukes’ A.
Of the 12 patients with ulcerative colitis, in one case the review of the diagnosis as a result of the failure of the intervention confirmed that they had Crohn’s disease. The intervention was performed in the same surgical act as the proctocolectomy in four patients. In one of them, the first in the series, both were performed urgently. In the remaining 12, the continent ileostomy was performed in another surgical act than that of the total proctocolectomy, which had been performed between one and ten years earlier in the same hospital.
The age of the patients ranges from nineteen to fifty-one years, with no predominance of sexes. The advantages and disadvantages of this intervention were previously explained to all before performing it, which, together with the selection criteria, allowed the option to reject.
Surgical technique
In all patients, the fourth model proposed by Kock was performed, using manual sutures with resorbable material or not, or mechanical sutures, using GIA suture devices. In four patients the valve was made following the original technique described by Kock. In the rest, the modification of Fazio and Bokey was adopted, consisting of fixing and rotating the mesentery of the handle that constitutes the valve by means of a merlex band. In nine of these patients, to ensure valve stability, three to four rows of staples were also used, using a GIA suturing machine, as described by Steichen. In five patients, the first in the series, a bypass ileostomy was performed above the reservoir to protect the pacinte from the complications of suture failure.
Postoperative care
Patients are treated with IV fluid therapy until enteric fluid is seen to exit through the reservoir drainage tube, at which time oral feeding is observed. Patients are discharged from hospital with the drainage tube inside the reservoir.
One month after the operation they are entered to carry out the learning of the intubation of the same. This is done initially every three to four hours, and after two months carry out this operation every eight to ten hours. Patients require a dietary restriction compared to patients with a conventional ileostomy, since foods with a high residue content that can obstruct the tube used to evacuate the reservoir must be removed.
Results
The morbidity observed is similar to that of several literature series, which present figures that range between 2 and 8%.
The only death observed is attributed to the procedure that occurred in the patient who underwent this intervention in emergency conditions, so this operation has not been performed again in patients with an acute episode of colitis.
The presence of suture failures such as the one that caused the death of this patient has occurred in other literature series more frequently than that observed in this case. Despite its drawbacks, this is a good technique if it is valued for its level of acceptance by patients.
