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The P-pouch: a New Ileal Reservoir Used in Restorative Proctocolectomy
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ÀÌÁÖºÀ ( Lee Joo-Bong )
ºÎ»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
À±¼ºÇÊ ( Yun Sung-Pil )
ºÎ»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
¿À³²°Ç ( Oh Nahm-Gun )
ºÎ»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
KMID : 0356720060220060363
Abstract
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¡¾0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3¡¾4.4 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¡¾0.3 and 423.5¡¾23.7 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£¾0.05). 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¡¾127.8 pmol/l vs. 1146.0¡¾150.0 pmol/l, P£¾0.05). Small intestinal transit time for healthy controls and the patient group averaged 89¡¾21 and 117¡¾12 minutes (P£¾0.05). The capacity of the ileal pouch was 372¡¾22 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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Ileoanal anastomosis;Restorative proctocolectomy;P-pouch;PYY
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