Kock's continent ileostomy: Results of 51 operations and experiences with correction of nipple-valve insufficiency

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Abstract
Fifty-one Kock's continent reservoir ileostomies were performed over a 4-year period. Immediate postoperative complications included 2 perforations of the reservoir, causing the death of 1 patient, 4 faecal fistulas and 8 intestinal obstructions. After a follow-up of more than 3 years in 22 cases, of 1-3 years in 21 cases and of less than 1 year in 8 cases an excellent functional result was attained after the first operation in 31 cases. Fifteen patients had to undergo reoperation owing to leakage of gas and bowel contents and difficulties in catheterization. Reoperation revealed three different causes of nipple insufficiency: total or partial sliding of the invaginate in 6 cases, dislocation of the nipple out of the reservoir in 6 cases and a fistula at the base of the nipple in 3 cases. Correction of the nipple-valve was performed using a modified invagination technique. After reoperation an excellent functional result was attained in 12 out of 15 cases. Thus, the functional result in the whole series was excellent in 43 patients. The symptoms of nipple-valve insufficiency appeared in most of the cases during the first 3-6 months post-operatively. Since there is a good chance that reoperation will correct the failure, the procedure should be carried out without delay after the appearance of disturbance in nipple-valve function.

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