Single lumen ileum with myectomy: A possible alternative to the pelvic reservoir in restorative proctocolectomy

Abstract

Abstract An alternative procedure to construction of a pelvic ileal reservoir was assessed which avoids the need for a pouch, while providing an adequate rectal substitute and good continence. Thirty-six female adult beagles were allotted randomly to undergo total colectomy with (a) ileo—anal anastomosis alone, (b) ileo-anal anastomosis with two 15 cm myectomies, (c) ileo-anal anastomosis and myectomy with an ileo-ileal valve, or (d) ileo-anal anastomosis with a duplicated J pouch. The animals were studied before operation and at 4-weekly intervals for 20 weeks after operation. Mortality rates were similar. Ileal compliance was increased significantly by myectomy from 0·64 ml/mm Hg (median, interquartile range 0·49–0·78) after ileo-anal anastomosis alone to 1·65 mmHg (1·16–1·93), P < 0·01, an increase which was maintained. Heal capacity was also increased both by myectomy and by the J pouch: ileo-anal anastomosis = 85 ml (75–100 ml), ileo-anal anastomosis and myectomy = 139 ml (116–156 ml), ileo-anal anastomosis and myectomy and ileo-ileal valve = 125 ml (range 85–145 ml), ileo—anal anastomosis and J pouch = 130 ml (range 75–165 ml) (P < 0·01). Bowel function in the other three groups was markedly superior to ileo—anal anastomosis alone. Mean transit time was significantly less after ileo—anal anastomosis, 5·2 h (2·6–8·2 h) than after both ileo—anal anastomosis and myectomy, 10·5 h (9·6–13·9 h), P < 0·05 and ileo-anal anastomosis and J pouch, 11·0 h (8·4–13·0 h), P < 0·05, but addition of an ileo-ileal valve did not produce a further increase in transit time, 12·9 h (range 10·5–14·5 h), P = n.s‥ Myectomy of single lumen ileum may be a useful alternative to a pelvic Heal reservoir in restorative proctocolectomy.