Antiperistaltic ileostomy using the long terminal ileal segment.

PURPOSE: This study was undertaken to determine whether reversed terminal ileal segments can be used to decrease ileostomy output in patients who have undergone total proctocolectomy and ileostomy for ulcerative colitis or familial adenomatous polyposis. METHODS: An approximately 25-cm length of terminal ileum was reversed in an antiperistaltic manner, and the new terminal ileal end was used for the ileostomy constructed in the usual manner. Six patients underwent this procedure and were compared with six patients who had conventional total proctocolectomy and ileostomy. Variables studied included weight of ileostomy output and the weight of the filtered fluid component. Data were obtained on seven different occasions during a two-month period beginning three months after the operation. Analysis was done using Student's t-test. RESULTS: There was a statistically significant decrease in the weight of the average 24-hour ileostomy effluent in those patients undergoing reversed antiperistaltic loop procedures. There was also a statistically significant decrease in the filterable liquid proportions. CONCLUSIONS: The antiperistaltic ileostomy is effective in reducing the daily amount of ileostomy effluent and facilitates stoma care, owing to its diminished liquid component.

Abdominopreanal proctocolectomy and ileal U-pouch in ulcerative colitis or familial adenomatous polyposis.

In some cases of ulcerative colitis and familial adenomatous polyposis, cancerous changes frequently occur on the distal rectum, in which case a restorative proctocolectomy is not recommended because of the limitations of a radical resection. Even if rectal cancer is not confirmed preoperatively, a strong possibility of cancer in the rectum could afford some support for a radical pelvic dissection during the anus-sparing procedure. The author designed a new operative procedure for resolving this problem. It is an abdominopreanal extrasphincteric proctocolectomy with preileal-pouch positioning of the distal ileal segment including the ileocecal sphincter (ileal U-pouch) for the treatment of ulcerative colitis and familial adenomatous polyposis coli (restorative radical proctocolectomy). The author performed this restorative radical proctocolectomy on seven patients over the past 5 years at the Department of Surgery, Pusan National University Hospital, of which four cases were ulcerative colitis and three were familial adenomatous polyposis. The results obtained were as follows: (a) The most common sequela was nocturnal seepage, which lasted for 6 months in 4 patients after the final operation. (b) The mean frequency of defecation was six times per day at 6 months after the final operation. (c) The average amount of stool was about 460g per day at 6 months after the final operation. Therefore, the ileal U-pouch is considered to be effective in reducing the daily amount of stool. A preanal extrasphincteric approach could be especially useful in the case of a difficult dissection of the anterectal space while also providing an effective dependent drainage of the ileoanal anastomotic space.