Abstracts
1997 Digestive Disease Week

Proctocolectomy with jejunal pouch-distal rectal anastomosis: an alternative to ileal pouch reconstruction.

M Takahashi, KA Kelly. Department of Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ.

Our aim was to determine whether a jejunal pouch-distal rectal anastomosis after proctocolectomy would provide better pouch capacity, more pouch propulsion and less bacterial stasis than would an ileal pouch-distal rectal anastomosis. A jejunal J pouch-distal rectal anastomosis was constructed in 6 dogs after proctocolectomy, maintaining neuromuscular continuity to the jejunal pouch by a neuromuscular bridge, while preserving flow of chyme (arrow in figure) through the ileum via a jejunoileostomy and an ileojejunostomy. Dogs with proctocolectomy and ileal J pouch-rectal anastomosis served as controls (n=6). Chronic enteric recording electrodes were implanted in all dogs. Five weeks after the operation, pouch motility was measured in the conscious animals using perfused pressure catheters and an electrical barostat passed per anum, electrical activity was recorded via the electrodes, and the number of bacteria per gram of stool was assessed by culture. Results: Dogs with a jejunal pouch had lower mean ± SEM basal pouch pressures, greater maximum barostat volumes with 3 mmHg intraluminal pressure, faster pacesetter potential (PP) frequencies in the pouch, more phase 3s of the interdigestive migrating myoelectric complex reaching the pouch, and fewer anerobic gram + cocci in their stools than did dogs with an ileal pouch. We conclude that a jejunal pouch has greater capacity, more cleansing contractions, and fewer fecal anerobic gram + cocci than an ileal pouch. A jejunal pouch may be an attractive alternative to an ileal pouch during reconstruction after proctocolectomy. [Figure not available.]

Type       Basal       Maximum     Frequency   # Phase 3s  # Dogs with
 of       pressure     volume       of PPs      reaching     anerobic
pouch     (mmHg)        (mL)        (cpm)        pouch        cocci
Jejunal  3.1 ± 0.5    76 ± 4.4   14.5 ± 0.4    37/43 (86%)      1
 Ileal   8.0 ± 1.5*   62 ± 3.9*  12.0 ± 0.7*   14/56 (25%)*     5
                           *p < 0.05 vs value above

Support was provided by Mayo Foundation, Tohoku University, Nigro grant.