A systematic description of continent ileostomy revision techniques.

PURPOSE: Comprehensive description of surgical techniques for revision of complications of continent ileostomy (CI). METHODS: By analyzing 133 revision procedures performed over 30 years, a systematically classified approach to the appropriate techniques for CI revision surgery has been derived. Based on the anatomic site and severity of the respective complication, four classes of revision surgeries have been defined: class 1 refers to the nipple valve, class 2 to the pouch, class 3 to the stoma, and class 4 to the afferent loop. The severity of the complication or the complexity of the revision procedure is indicated by a subdivision from a to d. RESULTS: The surgical variants (class 1a-d, class 2a-c, class 3a-b, and class 4a-b) are shown in schematic illustrations with accompanying descriptions of technical details, the respective fields of application, and the special indications. CONCLUSION: Based on these classes of revision surgeries, the specialized surgeon may find differentiated techniques at their disposal to save the CI and avoid unnecessary sacrifice of the artificial continence organ.

Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve.

PURPOSE: The aim of the study was to investigate the underlying cause of long-term complications in patients requiring at least one revision surgery of a continent ileostomy (CI) and to analyze functional outcome. METHODS: Only patients with CI at least one revision were included in the retrospective data analysis. Four different classes of complications (Cl A-D) were defined: Cl A = Nipple valve (NV), Cl B = pouch, Cl C = outlet (stoma), and Cl D = afferent loop (AL). Associations between underlying disease and origin of complications were analyzed. Cumulative probabilities were calculated using Kaplan-Meier analysis. RESULTS: A total of 77 patients were identified with a follow-up of 30 years, requiring 133 surgeries for 148 complications (c.). Cl A 49 c. (33.1%), Cl B 50 c. (33.8%), Cl C 39 c. (26.4%), and Cl D 10 c. (6.8%). Cl A and C complications were not correlated to underlying disease, whereas Cl B and D complications were only found in ulcerative colitis (UC) and Crohn's disease (CD). The cumulative probability of a second revision showed a linear rise, reaching 62.5% after 20 years. Cl A and B complications both reached 42.1%. Eleven (14.3%) patients (10 Cl B) had pouch failure in a follow-up period of 11.5 ± 8.7 years (1-31 years), whereas 66 (85.7%) had successful revisional surgery. Overall CI survival was 78.8% at 44 years. CONCLUSION: CI survival is limited by inflammatory complications of the pouch based on the underlying disease and not by mechanical limitations of the NV. TRIAL REGISTRATION NUMBERS: None.