A reconstructive operation on malfunctioning S-shaped pelvic reservoirs.

Patients with triple-loop pelvic reservoirs have often suffered from evacuation problems, clinically shown as the need for intubation, frequent stooling, leakage or ileoanal disruptions. In a recent study, the authors have shown that malposition of the reservoir and presence of a long, kinked, efferent limb constitute the main causes of these problems. A corrective operation consequently was designed in order to improve pouch topography. The pouch and its efferent conduit were completely mobilized and the efferent limb was shortened considerably. The reservoir then was placed in close proximity to the anus and the ileoanal anastomosis was reestablished. This operation now has been performed in seven patients who were considered "failures" and the results are gratifying. Six of these patients now have efficient evacuation and four are completely without leakage. Comparison of pre- and postoperative clinical and radiologic variables confirm the strong correlation between reservoir topography and clinical outcome.