Current status of the continent ileostomy.

The continent ileostomy has substantial advantages over the standard ileostomy in that it provides a socially acceptable, odourless, appliance-free stoma. The author presents the experience at the Toronto General Hospital from 1977 to 1984 with this procedure which was performed on 123 patients, in conjunction with proctocolectomy (36) and as a conversion from an ileostomy or colostomy (87). There were no postoperative deaths. Modifications to prevent nipple valve sliding have included the addition of staples across the valve and synthetic mesh slings around the outlet. Reservoir ileitis remains a difficult problem, most likely due to stagnant bacterial overgrowth. The operation should not be performed on patients with Crohn's disease, and in the obese, technical difficulties present considerable risk. The procedure should be confined to large centres where the surgeons are experienced in the procedure.