Use of ileal reservoir following proctocolectomy.

A study of 37 patients who underwent ileostomy and creation of an ileal reservoir revealed that all had satisfactory pouches. In the 24 patients in whom a nipple valve was created, the stoma was continent in 21. In the patients without a nipple valve, about one-half are continent. There have been no skin problems in any of the 37 patients. In two patients, the reservoir has been removed, one because of obstruction and the other at the election of the patinet. Although ileostomy with an ileal reservoir does not solve all of the problems, it offers patients who have undergone proctocolectomy for chonic ulcerative colitis or multiple neoplastic disease a better quality of life than does ileostomy alone. An appliance need not be worn constantly, and the stoma can be flush with the skin edge and placed low in the abdominal wall. Nevertheless, management problems do exist in some patients, and the patients are exposed to complications similar to those in any patient who has undergone a major abdominal surgical procedure that involves resection of intestine and creation of an intestinal stoma. Our group is optimistic regarding the use of this procedure in selected patients.