Physiological and pharmacological properties of a modified Brooke ileostomy: justification for retaining the most distal ileum.

PURPOSE

The traditional Brooke ileostomy removed the last 8-15 cm of the ileum due to concern of occurrence of terminal ileal Crohn's disease, vide infra the ileocolic sphincter was removed. Retaining all the terminal ileum has the potential of retaining the ileocolic sphincter. Our aim was to investigate whether a high-pressure zone existed within the last few centimetres of the ileum and its response to pharmacological stimuli.

METHODS

A balloon manometry catheter was introduced into the stoma of 16 patients who had formation of an end ileostomy (ileocolic sphincter retained, ICS). Recordings were made at 1 cm intervals from the meatus in order to identify the maximum intra-luminal resting and intra-abdominal pressure. At the point of maximum resting pressure, the response to phenylephrine (10% gel) and glyceryl trinitrate (GTN) (0.2% paste) was recorded. Results were recorded using an Ohmeda Oestiva 5 manometry system (in millimeter of mercury) and data were analysed using ANOVA. Results were compared with 13 historical controls (ileocolic sphincter removed).

RESULTS

There was no significant difference in resting intra-abdominal pressure between the two groups (historical controls 8.5 ± 3.0 mmHg; ICS 9.0 ± 3.2 mmHg), p = NS. The maximum resting intra-luminal pressure in ICS patients exceeded historical controls 16 ± 2.9 vs 10.0 ± 2.5 mmHg, p < 0.001. In ICS patients, phenylephrine increased the resting pressure to 26.0 ± 3.5 mmHg, p < 0.001. In historical controls, the pressure remained unchanged, 12 ± 4.7 mmHg, p = NS. Subsequent addition of GTN to both groups lowered maximum intra-luminal pressure to pre-study values, 10 ± 4.2 mmHg (ICS) and 7 ± 3.5 mmHg (controls), p = NS.

CONCLUSION

Retention of the ileocolic sphincter in a modified Brooke ileostomy preserves a physiological high-pressure zone, the properties of which can be modified by pharmacological agents.