2005 Abstracts: Peristaltic Inhibition Not Volume Is the Important Functional Principle of Ileal J- and Transverse Ileal-Pouch Procedures in Pigs
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Peristaltic Inhibition Not Volume Is the Important Functional Principle of Ileal J- and Transverse Ileal-Pouch Procedures in Pigs
Friedrich Hubertus Schmitz-Winnenthal, University of Heidelberg, Department of Surgery, Heidelberg, Badenwürtemberg, Germany; Martina Kadmon, University of Heidelberg, Department of Surgery, Heidelberg, Badenwürtemberg; Erwin Schwab, Bruno Schmidt, Ulf Hinz, University of Heidelberg, Department of Surgery, Heidelberg, Badenwürtemberg, Germany; Rainer Nobiling, University of Heidelberg, Department of Physiology, Heidelberg, Badenwürtemberg, Germany; Karin Blaeuer, Markus W. Büchler, University of Heidelberg, Department of Surgery, Heidelberg, Badenwürtemberg, Germany; Kaspar Z'graggen, Klinik Beau-Site Hirslanden, Bern, Bern, Germany
Introduction:
Restorative proctocolectomy followed by an ileoanal J-pouch procedure is the therapy of choice in patients with FAP and in a subgroup of patients with UC. In this work we to study the functional principle and the early postoperative outcome of different ileal pouch designs in a pig model. The aim was to define whether ileal neorectal reservoirs are effective through an antiperistaltic mechanism or through the creation of volume. A novel ileal pouch design, the transverse ileal pouch (TIP), was evaluated and compared with the standard J-pouch and a straight ileoanal anastomosis. Methods: Twenty-three pigs underwent restorative proctocolectomy followed by reconstruction with a straight ileoanal anastomosis (IAA; n=5), a J-pouch (JP; n=6) or a transverse ileal pouch (TIP; n=10). Pigs were followed for one week postoperatively. Peristaltic function was assessed by simultaneuous multichannel manometry proximal to the pouch, within the pouch and distal to the pouch and a Fourie - analysis was performed to measure the functional effect of pouch formation on peristalsis. The in-situ volume of the neorectal reservoirs was measured by triple contrast computed tomography and 3D- reconstruction. Clinical outcome parameters were the general condition of the animals, postoperative feeding habits, stool consistency and stool frequency. Results: Seventeen animals survived one week. There was no difference in the general condition and the feeding habits of the animals in the three groups. The Fourie-Analysis demonstrated a peristaltic brake (inhibition of the properistalsis) within the pouch in the JP and TIP groups, but not in IAA animals. The in situ volume of the neorectal reservoirs did not differ significantly between the three groups. Stool consistency was better in the TIP group (7/10 with good consistency) than in the JP group (0/6) and the IAA group (1/5) (p= 0.01). The TIP group also had the lowest stool frequency (3.2 +/- 1.14 per day) on day 6 after the operation, compared with the JP group(5.33 +/- 1.03) and the IAA group (4.6 +/- 1.82; p=0.004). Conclusion: Ileoanal neorectal reservoirs (JP and TIP) after proctocolectomy function through a peristaltic brake mechanism in the early postoperative period which seems to be independent from the volume created during pouch formation. The TIP resulted in similar functional results than the ileal JP, but in better clinical outcome than the JP and IAA reconstruction in a pig model.
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