Skip to main content

Advertisement

SpringerLink
Log in

Continent ileostomy simplified by musculo-serosal window

An experimental study

  • Published:
Diseases of the Colon & Rectum

Abstract

Experience with pouch procedures in the quest for continence after total panproctocolectomy has been associated with significant reoperation rates, making these procedures suitable only for highly selected and motivated patients. The purpose of this study was to determine, in an acute dog model, the optimum configuration of a new continence mechanism consisting of a musculo-serosal window formed between the afferent and efferent loops of small bowel. The following geometric measures were varied: single or double window (efferent and afferent loops, respectively); percent circumference of bowel wall used for the window; and distance between pouch apex and window. Intraluminal pressure against volume infused in standard time was recorded. Four hundred seventy experiments in 47 pouches were conducted. The authors suggest that the optimal configuration for this “valve” is bowel circumference used for the window—50 to 60 percent on both the afferent and efferent loops, with a pouch-valve distance of 5 to 6 cm. It is concluded that a biologic valve obviating the need for a nipple may be possible. The geometric configuration has been defined and should be studied in a chronic animal model to determine long-term results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brooke BN. Management of an ileostomy. Lancet 1952;2:102–4.

    Article  PubMed  CAS  Google Scholar 

  2. Turnbull RB. Management of an ileostomy. Am J Surg, 1953;86:617–24.

    Article  PubMed  Google Scholar 

  3. Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Arch Surg 1969;99:223–31.

    PubMed  CAS  Google Scholar 

  4. Kock NG. Ileostomy without external applicances: survey of 25 patients provided with intraabdominal reservoir. Ann Surg 1971;173:545–50.

    Article  PubMed  CAS  Google Scholar 

  5. Kock NG, Myrvold HE, Nilsson LO, Philipson BM. Continent ileostomy. Acta Chir Scand 1969;147:67–72.

    Google Scholar 

  6. Fendel EH, Fazio VW. Construction of a continent ileostomy using a porcine aortic valve: a preliminary report. Dis Colon Rectum 1982;25:21–3.

    Article  PubMed  CAS  Google Scholar 

  7. Papachristou DN. A simplified method of continent ileostomy: experimental observations. Am Surg 1981;47:548–50.

    PubMed  CAS  Google Scholar 

  8. Cranley B, McKelvey ST. The Kock ileostomy reservoir: an experimental study of methods of improving valve stability and competence. Br J Surg 1981;68:545–50.

    PubMed  CAS  Google Scholar 

  9. Bayer I, Feller N, Chaimoff CH. A new approach to the nipple in Kock's reservoir ileostomy using Mersilene® mesh. Dis Colon Rectum 1981;24:428–31.

    PubMed  CAS  Google Scholar 

  10. Kock NG, Myrvold HE, Nilsson LO. Progress report on the continent ileostomy. World J Surg 1980;4:143–7.

    Article  PubMed  CAS  Google Scholar 

  11. Goligher JC, Lintott D. Experience with 26 reservoir ileostomies. Br J Surg 1975;62:893–900.

    PubMed  CAS  Google Scholar 

  12. Cranley B. The Kock reservoir ileostomy: a review of its development, problems and role in modern surgical practice. Br J Surg 1983;70:94–9.

    PubMed  CAS  Google Scholar 

  13. Gerber A, Apt MK, Craig PH. The Kock continent ileostomy. Surg Gynecol Obstet 1983;156:345–50.

    PubMed  CAS  Google Scholar 

  14. Schrock TR. Complications of continent ileostomy. Am J Surg 1979;138:162–9.

    Article  PubMed  CAS  Google Scholar 

  15. Flake WK, Altman MS, Cartmill AM, Gilsdorf RB. Problems encountered with the Kock ileostomy. Am J Surg 1979;138:851–5.

    Article  PubMed  CAS  Google Scholar 

  16. Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980;67:533–8.

    PubMed  CAS  Google Scholar 

  17. Fonkalsrud EW. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg 1984;199:151–7.

    Article  PubMed  CAS  Google Scholar 

  18. Utsunomiya I, Imajo M, et al. Total colectomy, mucosal proctectomy and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.

    Article  PubMed  CAS  Google Scholar 

  19. Orangio GR, Bronsther B, Abrams M, Wise L. A new continent ileostomy. Surg Forum 1983;34:196–9.

    Google Scholar 

  20. Orangio GR, Bronsther B, Abrams M, Wise L. A new continent ileostomy: results of an animal study. Dis Colon Rectum 1984;27:238–43.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut

    J. Mouchizadeh M.D., G. Papanicolaou M.D. &  L. P. Fielding M.B., F.R.C.S., F.A.C.S. (Chief of Surgery)

Authors
  1. J. Mouchizadeh M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Papanicolaou M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. P. Fielding M.B., F.R.C.S., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Read at the meeting of the American College of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15, 1986.

Supported by Grant 738J-41-75239 St. Mary's Hospital.

About this article

Cite this article

Mouchizadeh, J., Papanicolaou, G. & Fielding, L.P. Continent ileostomy simplified by musculo-serosal window. Dis Colon Rectum 30, 858–862 (1987). https://doi.org/10.1007/BF02555424

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02555424

Key words

Search

Navigation