Continent ileostomy simplified by musculo-serosal window. An experimental study.

Experience with pouch procedures in the quest for continence after total panproctocolectomy has been associated with significant reoperation rates, making these procedures suitable only for highly selected and motivated patients. The purpose of this study was to determine, in an acute dog model, the optimum configuration of a new continence mechanism consisting of a musculo-serosal window formed between the afferent and efferent loops of small bowel. The following geometric measures were varied: single or double window (efferent and afferent loops, respectively); percent circumference of bowel wall used for the window; and distance between pouch apex and window. Intraluminal pressure against volume infused in standard time was recorded. Four hundred seventy experiments in 47 pouches were conducted. The authors suggest that the optimal configuration for this "valve" is bowel circumference used for the window--50 to 60 percent on both the afferent and efferent loops, with a pouch-valve distance of 5 to 6 cm. It is concluded that a biologic valve obviating the need for a nipple may be possible. The geometric configuration has been defined and should be studied in a chronic animal model to determine long-term results.