COMPLICATIONS RELATED TO DIFFERENT CONTINENCE MECHANISMS IN ILEOCECALRESERVOIRS

Purpose: We compared the incidence, treatment and outcome of complicat ions related to different continence mechanisms in a single institutio nal series of continent urinary diversions using an ileocecal reservoi r. Materials and Methods: From November 1990 through October 1996 in 1 93 consecutive cases an ileocecal pouch (Mainz I) was used as a low pr essure, high capacity reservoir. A submucosally embedded in situ appen dix was used in 96 patients (mean age 57.2 years, mean followup 35.6 m onths) and an ileal intussusception valve was used in 106 (mean age 58 .4, mean followup 33.1 months). Without exception the stoma was placed in the umbilicus. Results: In 172 patients (85.2%) no stoma related c omplication was observed. In 17 patients (17.7%) with appendix stoma 2 3 reinterventions were performed, for appendico-umbilical stenosis in all but 2 cases (15.6%), occurring after a mean of 20.4 months. Two co mplete appendix necroses required replacement by ileal nipple. Stomal stenoses could be corrected as minor outpatient procedures. In 13 of 1 06 patients (12.3%) with intussuscepted ileal nipple a second operatio n became necessary after a mean interval of 9.6 months (partial/comple te necrosis of nipple in 4 cases, dislocation of nipple from ileocecal valve in 3, detachment from fascia in 4 and stomal stenosis in 2). Wh ereas no calculi were observed in the appendix group, stones had to be removed from 3 patients (2.8%) with ileal nipple. Conclusions: In sit u appendix and intussuscepted ileal valve techniques are satisfactory in providing ileocecal reservoir continence. Besides the known advanta ges of the appendix as the primary reconstructive approach, the treatm ent of subsequent complications is simple. Therefore, whenever an appr opriate appendix is encountered it should be the intestinal segment of choice in forming a continence mechanism.