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KMID : 0356720060220060363
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Journal of the Korean Society of Coloproctology
2006 Volume.22 No. 6 p.363 ~ p.370
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The P-pouch: a New Ileal Reservoir Used in Restorative Proctocolectomy
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Lee Joo-Bong
Yun Sung-Pil
Oh Nahm-Gun
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Abstract
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Purpose: To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy.
Methods: There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15±0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3±4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit.
Results: In the patient group, daily stool frequency and volume were 5.2±0.3 and 423.5±23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P＞0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0±127.8 pmol/l vs. 1146.0±150.0 pmol/l, P＞0.05). Small intestinal transit time for healthy controls and the patient group averaged 89±21 and 117±12 minutes (P＞0.05). The capacity of the ileal pouch was 372±22 ml, and the efficiency of ileal reservoir evacuation was 76 %.
Conclusion: The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler. J Korean Soc Coloproctol 2006;22:363-370
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KEYWORD
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Ileoanal anastomosis, Restorative proctocolectomy, P-pouch, PYY
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