Antiperistaltic Ileal Segment in the Prevention of Ileostomy Diarrhea

The main problem facing patients with ulcerative colitis after mucosal proctectomy and ileo-anal anastomosis (MP + IAA) is severe frequency of bowel action. Although the addition of a pelvic reservoir can improve matters, some patients still complain of this problem. In an attempt to slow transit, enhance absorption and improve function, we investigated the effects on these parameters of a reversed ileal segment, an artificial valve in an animal model. Studies were conducted before and after operation. The dogs randomly underwent either colectomy and low ileorectal anastomosis (IRA) alone (control, n = 12), IRA with a 10 cm reversed loop (IRA + RL, n = 10) or IRA with an artificial valve (IRA + valve, n = 10). Operative mortality rates were similar in the groups. Mean transit time (MTT) was significantly reduced after the control operation and after IRA + RL but not after IRA + valve. In addition MTT after IRA + valve (21 +/- s.d., 3.4 h) was significantly greater than in the other two groups (control = 12.1 +/- 4.3 h, IRA + RL, 12.8 +/- 5.5 h, P less than 0.04) and frequency of bowel actions seemed less. Measurements of absorption and nutritional state, however, did not differ significantly between the groups. Thus, although the artificial valve made no difference to absorption, it did prevent the reduction in MTT that occurred after the control operation whereas the reversed loop did not. This effect might thus benefit patients who undergo MP + IAA.

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Ileostomy using an interposed ileal segment to function as a ‘neocolon’

Nakahara

Taylor

Schirmer

1990

Diseases of the Colon &Amp; Rectum

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A new type of ileostomy was constructed in rats using an interposed ileal (I-I) segment functioning as a neocolon. The effects of this operation in these rats were compared with a control group undergoing conventional ileostomy (I). Rats in the I group lost weight throughout follow-up, whereas rats in the I-I group regained weight and were significantly heavier four weeks after surgery. Transit time from the stomach to the stoma was significantly prolonged in the I-I group (187 +/- 29 minutes) when compared with the I group (141 +/- 17 minutes, P less than 0.01). Serum analysis revealed no significant differences in total protein, lipids, electrolytes (Na, Cl, CO2), and osmolarity between the groups. Biliary bile salt concentration, normalized bile flow, and normalized bile acid output in the I-I group were not different from those in unoperated control rats, suggesting unimpaired bile acid metabolism. These data suggest this operative procedure has the beneficial effects of slowing intestinal transit and promoting postoperative recovery without impairing distal ileal function.

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Antiperistaltic Ileal Segment in the Prevention of Ileostomy Diarrhea

Cited by 7 publications

References 15 publications

Reversed Ileal Segment for Treatment of Ileostomy Dysfunction

Reversed Ileal Segment for Treatment of Ileostomy Dysfunction

The effect of a reversed ileal segment and artificial valve on intestinal transit and absorption following colectomy and low ileo-rectal anastomosis in the dog

Ileostomy using an interposed ileal segment to function as a ‘neocolon’

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