Effect of terminal ileal transposition on intestinal absorption following proctocolectomy

Hotokezaka, Masayuki; Nakahara, Shosaku; Iwamoto, Takuya; Chijiiwa, Kazuo; Mibu, Ryuichi

doi:10.1002/bjs.1800830416

Cited by 8 publications

(1 citation statement)

References 30 publications

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“…Ileocecal Graft Pouch for Total Gastrectomy following the terminal ileal transposition procedure [31]. Moreover, the mid-jejunum also showed a high rate of absorption for bile acids, glucose, and chloride after this procedure.…”

Section: Discussionmentioning

confidence: 98%

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Medeiros¹,

Filho²,

Medeiros³

et al. 2007

Journal of Investigative Surgery

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After total gastrectomy, the ileocecal graft may act as a reservoir and protect against reflux but give rise to transposition of the ileum and cause possible changes in bile acid metabolism and nutrition. This study compared the ileocecal graft and jejunal pouch. Male Wistar rats weighing 265 +/- 22 g were submitted to sham operation (S), ileocecal interposition graft (IIG), and jejunal pouch interposition graft (JP) after total gastrectomy. Eight weeks later, the esophagus was examined for evidence of esophagitis. Nutritional biochemistry and weight profile were documented preoperatively and 8 weeks after surgery. The oral glucose tolerance test was performed. Thirty-three rats were operated on and 30 survived for 8 weeks. Esophagitis occurred in seven JP rats. Body weight was significantly higher in IIG than in JP rats (p < .05). Normal glucose tolerance to intragastric glucose load was observed in sham and operated rats. JP rats had a significant decrease in serum albumin, glucose, transferrin, hemoglobin, iron, folate, and calcium, compared to sham (p < .05). Cobalamine was significantly lower in IIG rats than in JP rats (p < .05). In the IIG and JP groups, serum/hepatic total bile acid did not differ significantly from preoperative and sham values. In conclusion, the IIG interposition graft in rats prevented esophagitis, preserved nutrition, and did not interfere with enterohepatic total bile acid circulation.

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Section: Discussionmentioning

confidence: 98%

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Medeiros¹,

Filho²,

Medeiros³

et al. 2007

Journal of Investigative Surgery

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Die Physiologie des intestinalen Pouches

Teixeira

Kelly

1999

Chirurg

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To summarize, J-shaped and W-shaped ileal pouches serve as adequate neorectal reservoirs after proctocolectomy. These pouches anastomosed directly to the anal canal are as distensible and capacious and as readily evacuated as the rectum in health. However, the use of S- or H-shaped ileal pouches, which have efferent limbs positioned between the pouch and the anal canal, sometimes leads to outflow obstruction and incomplete evacuation. There is little doubt that neorectums made of ileum can allow patients to have entirely "normal" patterns of fecal continence. Nonetheless, with pouch distension, large-amplitude, propulsive pouch contractions occur. These large pressure waves bring on the urge to defecate. They stress the anal sphincters more acutely than either the infrequent, small-amplitude, nonpropulsive contractions or clustered contractions of the healthy rectum. Nonetheless, patients learn to recognize the different signals heralding the impending need for evacuation from the ileal pouch and deal with them. Jejunal pouches, because of their greater distensibility and larger capacity, and the greater frequency of interdigestive migrating myoelectric complexes (MMCs) occurring in them, hold the promise of being a better rectal substitute than ileal pouches. They are more difficult to construct, however. Colonic pouches, when anastomosed to the anal canal after rectal resection, also act as adequate fecal reservoirs. Their main drawback is the inability of some patients to empty them. Small (5 cm) colonic pouches seem to empty better than larger (10-15 cm) ones. Jejunal pouches and colonic segments used as gastric substitutes after gastrectomy provide a better reservoir for ingested food than straight jejunal segments. The main drawback of the pouches is their inability to triturate the solid content of a meal and to regulate the rate of its emptying into the small intestine. Liquids and solids likely empty from these pouches at the same rate, in contrast to the slower emptying rate of solids from the healthy stomach. This likely leads to maldigestion of solids, perhaps contributing to the weight loss often found after gastrectomy.

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Terminal ileal transposition procedure in ileoanal anastomosis following proctocolectomy

Mibu

Oohata

Ishikawa

et al. 1998

International Journal of Colorectal Disease

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We introduced a terminal ileal transposition procedure (TITP) in ileal pouch-anal anastomosis, in which a 50 to 70 cm isolated ileal segment 20 to 40 cm from the ileocecal valve was interposed between the terminal ileum and the anus. Twelve patients underwent this procedure in two or three-staged operations. Mean stool frequency per 24 hours was 4.4 +/- 1.7, and stool consistency was formed and soft in all patients at the mean of 13 months after TITP. We observed neither surgical technique-related complications nor metabolic disorders, except for iron deficiency anemia, during and after the operations. The serum level of vitamin B12 significantly increased after the operation in eight patients (P < 0.05). TITP has advantages such as preventing the terminal ileum from metabolic dysfunction due to pouchitis, avoiding sacrifice of the terminal ileum in the two-staged operation, and obviating the need for reconstruction of ileostomy in the three-staged operation. It may also promote intestinal absorption and reduce late metabolic complications.

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Effect of terminal ileal transposition on intestinal absorption following proctocolectomy

Cited by 8 publications

References 30 publications

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Die Physiologie des intestinalen Pouches

Terminal ileal transposition procedure in ileoanal anastomosis following proctocolectomy

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