Evolution of ileostomy surgery.

Ileostomy in association with proctocolectomy in one or two stages is the accepted treatment for ulcerative colitis. There are many difficulties in managing the permanent ileostomy in spite of improvements in design and construction, in availability of stomal appliances and in better skin protection and adhesive materials. The collection and storage of excrement in a bag outside the body imposes severe difficulties. To eliminate these problems an alternative ileostomy method, the continent ileostomy, was devised and the clinical results achieved in 314 patients are reported. There was a 2.2% overall operative mortality but no operative deaths in the last consecutive series of 152 patients. The nonfatal complication rate has decreased from 24% to 7% and revision because of a malfunctioning outlet valve has decreased from 54% to 6%. At follow-up 94% of the patients were continent. Except for a slightly increased loss of bile salts and a potential risk of decreased vitamin B12 absorption no harmful effects of the reservoir procedure have been found after observation times up to 12 years.