P437 Reoperations and long-term survival of Kock’s continent ileostomy in Inflammatory bowel disease patients: a population based national cohort study from Sweden.
Risto, A.(1);Andersson, R.E.(1);Landerholm, K.(1);Bengtsson, J.(2);Block, M.(2);Myrelid, P.(1);
(1)Linkoping University, Department of Biomedical and Clinical Sciences- Faculty of Health Sciences- Linköping University- Linköping- Sweden., Linköping, Sweden;(2)Sahlgrenska University Hospital, Department of surgery- colorectal unit., Gothenburg, Sweden;
Kock’s continent ileostomy is an option after proctocolectomy for patients not suitable for ileal pouch anal anastomosis or ileorectal anastomosis. Ulcerative colitis is the most common indication for continent ileostomy. The aim of this study was to evaluate the long-term outcome of continent ileostomy.
All patients with inflammatory bowel disease and a continent ileostomy were identified from the Swedish National Patient Register. Data on demographics, diagnosis, reoperations, and excisions of the continent ileostomy was obtained. Patients with inconsistent diagnostic coding were classified as IBD-unclassified.
Some 727 patients were identified, 428 (59%) with Ulcerative colitis, 45 (6%) with Crohn’s disease and 254 (35%) with IBD-unclassified. After a median follow-up time of 27 (IQR 21-31) years 191 (26%) patients had never had revisional surgery. Some 1,484 reoperations were performed on 536 (74%) patients, the median number of reoperations was 1 (IQR 0-3) per patient. The continent ileostomy was excised in 77 (11%) patients. Reoperation within the first year after reconstruction was associated with higher rate of revisions (IRR 2.90 p<0.001) and shorter time to excision (HR 2.38 p<0.001). Constructing the continent ileostomy after year 2000 was associated with increased revision and excision rates (IRR 2.7 p<0.001 and HR 2.74 p=0.013). IBD-unclassified was associated with increased revisions (IRR 1.3 p<0.001) and the proportion of IBD-unclassified patients almost doubled from the 1980s (32%) to after 2000 (50%).
Continent ileostomy is associated with substantial need for revisional surgery, but most patients get to keep their reconstruction for a long time.