Abstracts
1999 Digestive Disease Week

# 2188 THE ILEOCECAL RESERVOIR
Gaudenz Curti, Kantonsspital Luzern, Luzern Switzerland; J Metzger, Christian Hamel, Dept of Surg, Luzern Switzerland; F Harder, Markus Von Flue, Kantonsspital Luzern, Luzern Switzerland

Introduction: The choice of the best reconstruction-technique following resection of either the stomach or the rectum remains a matter of discussion. While there is no problem to reconnect intestinal segments, which do not serve as a reservoir, there are many different operation techniques to replace the stomach and the rectum producing significantly different functional results. The ileocecal segment offers an excellent intestinal reservoir combined with an antireflux mechanism thus presenting an ideal replacement for the stomach. For the replacement of the rectal reservoir too, the ileocecal segment may be used in first line. Method: the ileocecal segment was used in 20 patients following gastric resection and lymphadenectomy to reconstruct the intestinal passage between the esophagus and the duodenal stump (group A). In some further 44 patients (group B) the ileocecal segment was used to replace the rectum between the descending colon and the dentate line following resection for very low rectal cancer. Mortality and morbidity were investigated in both groups. In group A quality-of-life, weight loss, dumping and reflux symptoms were evaluated. In group B continence, discrimination, defecation quality, urge and the patients' satisfaction were investigated. All data were recorded prospectively. Results: Early and late mortality were not different compared to other reconstruction types. In each group one patient died within 60 days postoperatively due to myocardial infarction. The morbidity following stomach replacement was 20%, following rectal replacement 4.6% during the hospital stay and 13.8% during follow up, respectively. One patient complained about heartburn but endoscopically no pathology was detected in any patient. 3 months postoperatively the patients' weight remained stable or started to increase. 3 months following rectal replacement patients were continent in 87% with further improvement over 2 years. Soiling mainly during night times remained over 2 years in 44%. 88% of the patients were completely satisfied 2 years postoperatively. Conclusion: The replacement of either the stomach or the rectum using the ileocecal segment with adequate surgical technique is safe and produces excellent functional outcome regarding the reconstruction of the intestinal passage as well as the reservoir function of the primary organ. Furthermore, preservation of the duodenal passage after gastrectomy may prevent dysregulation of the endocrine and exocrine pancreatic harmones.

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