Abstracts
2001 Digestive Disease Week

# 2411 Antiperistaltic Cecal Reservoir For Refractory Colonic Inertia
Jonathan S. Fisher, Tom Galouzis, Michael McGrail, Seth A. Rosen, Eli Ehrenpreis, John C. Alverdy, Chicago, IL

BACKGROUND: The current accepted surgical option for colonic inertia refractory to medical management is total abdominal colectomy with ileoproctostomy. Problems with this approach include diarrhea, nocturnal discharge, and socially unacceptable urgency. Below we describe our early success with an antiperistaltic cecal reservoir for refractory colonic inertia.

METHODS: Eleven patients underwent the procedure. Ten cases were done through laparotomy. One patient underwent the procedure by hand-assisted laparoscopic technique with the handport placed through a Pfannenstiel incision. The surgical technique entailed a subtotal abdominal colectomy sparing the cecum and 5 cm of ascending colon. Following subtotal colectomy, the base of the cecum was anastomosed to the rectum using a 31 EEA stapler passed from the "blind" end of the ascending colon through the appendiceal stump. The blind end of the ascending colon was closed with a linear stapling device.

RESULTS: There were no intraoperative complications. Two wound infections required open packing. Two cases of postoperative abdominal distension required temporary placement of a rectal tube. The average length of stay was 7.2±2.3 d. The average number of stools in a 24 hr period at discharge was 3±2. Six month follow up demonstrated no re-admissions for dehydration. The average number of stools per day at 6 months was 2.8±1.3. No patient experienced nocturnal discharge, incontinence of flatus or stool, or socially unacceptable urgency to defecate.

CONCLUSIONS: Antiperistaltic cecal resevoir for chronic colonic inertia appears to be well tolerated with an acceptable complication rate. Preservation of the ileal brake and the use of a large volume reservoir such as the cecum may explain the low number of stools and absence of incontinence and urgency. Prevention of microbial colonization of the ileum by an intact ileocecal valve may also contribute to better intestinal homeostasis. Randomized prospective trials comparing this technique to conventional ileoproctostomy will be necessary to prove the superiority of an antiperistaltic cecal reservoir in the treatment of colonic inertia.