The following is a summary of the “Redo Continent Ileostomy in Patients With IBD: Valuable Lessons Learned Over 25 Years,” published in the March 2023 issue of Hematology by Duraes, et al.
The purpose of this research was to examine the long-term effects of a redone continent ileostomy. Cohort research that looks backward in time. This research was carried out at a specialist, high-throughput unit for colorectal surgery. Patients with a redo continent ileostomy (neo-pouch construction or significant procedures modifying the pouch geometry) for inflammatory bowel disease between 1994 and 2020 were identified. Patient demographics, short-term and long-term results, and quality of life were the primary outcomes measured.
The final tally of included patients was 168; of them, 102 (61% of the total) were female; the average age was 51 (±13.1), and the average body mass index was 24.4 (±3.9). An average of 16.8 years passed between the first continent ileostomy and the subsequent revision. Redo surgery patients were 122 with ulcerative colitis (73%), 36 with Crohn’s disease (21%), and 10 with indeterminate colitis (6%). The majority of patients who needed a redo continent ileostomy did so because of a slipped nipple valve or a valve stricture (86%). About 48 patients (29%) needed another operation, while 27 patients (16%) experienced pouch failure after a median of 4 years. At 3 years, the pouch survival rate was 89%; at 5 years, 84%; and at 10 years, 79%.
A shorter time between primary and redo continent ileostomy was related to long-term pouch failure on univariate analysis (P = 0.003). A shorter time between surgeries was found independently related to pouch failure in a multivariate analysis using the Cox regression model (P = 0.014). About 70 patients filled out the questionnaire, yielding a mean Cleveland Clinic Global Quality of Life score of 0.61 (±0.23). This was a retrospective, single-center study with a rather low response rate on the Global Quality of Life questionnaire, which were the main drawbacks. Nevertheless, improved quality of life and a 79% long-term pouch retention rate are linked to redoing continent ileostomy surgery. Consequently, individuals determined to retain their continent ileostomy should be offered redo surgery.