Development of a systematic approach to conversion of the ileoanal pouch into continent ileostomy.

ABSTRACT

Based on practical experience, a systematic approach to conversion of ileal J-pouches into continent ileostomies is developed by defining three types of conversion surgery, each with two subtypes. Type 1 refers to conversion without pouch reconstruction, type 2 to partial pouch reconstruction, and type 3 to complete pouch reconstruction. The subdivisions (a and b) take into account whether the afferent loop of the former pelvic pouch (a) or a higher ileal/jejunal segment of the small intestine (b) is used in conversion and/or reconstruction. The six resulting surgical variants are shown in schematic illustrations with accompanying descriptions of technical details to provide the specialized surgeon with comprehensive technical guidance.