Digest This - Special Edition 2008 - (Page 6)

cleveland clinic continent ileostomy: a valuable option In 2006, a comprehensive report by Cleveland Clinic showed that a complicated, colostomy-sparing procedure known as a “continent ileostomy” provided excellent long-term results and quality-of-life outcomes. So far, says one of the principal physicians involved, the procedure’s success rate is standing the test of time. “our extensive experience with the procedure comprises 330 patients in the past 20 years,” says Cleveland Dr. David Dietz “As with any surgical procedure, and especially with one as complex as continent ileostomy creation, surgeon experience is probably the most important factor to determine ultimate outcome,” Dr. Dietz says. “We have the greatest experience with this procedure of any tertiary referral center in the U.S.” Victor W. Fazio, MD, an internationally recognized expert on colorectal surgery and Chairman of the Digestive Disease Institute, established Cleveland Clinic as the leading referral center for K-pouch patients. His training of Drs. Dietz, Kiran and Remzi in the procedure has helped the Digestive Disease Institute make the procedure more widely available to its patients. Dr. Dietz’s experience in performing the operation began in 2001 at Washington University School of Medicine in St. Louis after he completed training at Cleveland Clinic. “Because of this experience, I was recruited back to Cleveland Clinic this past year in order to help maintain continuity of care for these patients,” Dr. Dietz says. Such maintenance is crucial because some patients with K-pouches need revision surgery to correct problems with the valve mechanism. “In our experience, approximately 30 percent of patients will develop ‘slippage’ of the valve, which can lead to valve incontinence,” he says. The slipped valve has always been the Achilles’ heel of the continent ileostomy and has been reported to occur in up to 50 percent of patients. Fortunately, surgery can correct slipped valves in most patients. Dr. Dietz says Digestive Disease Institute experts continue to investigate potential solutions to this problem. In the meantime, however, he says the K-pouch continues to provide a valuable option for a select population of patients. Clinic colorectal surgeon David Dietz, MD. “First and foremost, it is a safe operation in our hands, as evidenced by the remarkably low post-operative mortality rate of 0.3 percent. We have also had very good results with the durability of the procedure. Examination of our results found that 80 percent of patients still had a functioning pouch 20 years after surgery. This is a very high number.” The three Cleveland Clinic Digestive Disease Institute surgeons who perform the procedure – Dr. Dietz, Victor Fazio, MD, Ravi Kiran, MD, and Feza Remzi, MD – have a level of expertise that helps minimize potential complications or failure. Continent ileostomy is an option when an ileal pouch surgery is not possible or the initial and subsequent repeat ileoanal pouch surgery failed, and the patient is reluctant to accept a permanent ileostomy. The continent ileostomy, or Kock pouch (pictured above), is a complex procedure. Three loops of small bowel (approximately 20 inches) are used to fashion a pouch and a one-way valve that allows patients to forgo wearing an outer appliance. Those with a “K-pouch” cannulate the stoma on their own three or four times a day to remove fecal matter through the valve. For more information, email digestthis@ccf.org {6} Digest This Special Edition | 2008

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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